Form Op-1 - Application For Motor Property Carrier And Broker Authority Page 13
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16FORM OP-1 Revised 01/10/2017
OMB No.: 2126-0016 Expiration: 01/31/2020
Section
4
SAFETY CERTIFICATION
For vehicle-operating applicants only. (Select only one.)
30. APPLICANTS SUBJECT TO FEDERAL MOTOR CARRIER SAFETY REGULATIONS.
If you will operate vehicles of more than 10,000 pounds GVWR and are, thus, subject to pertinent portions of the USDOT’s Federal Motor
Carrier Safety Regulations (FMCSRs) at
49 CFR, Chapter 3, Subchapter B (Parts
350-399), you must certify as follows:
Applicant has access to and is familiar with all applicable USDOT regulations relating to the safe operation of commercial vehicles and
the safe transportation of hazardous materials, and will comply with these regulations. In so certifying, applicant is verifying that, at a
minimum, it:
(1) Has in place a system and an individual responsible for ensuring overall compliance with FMCSRs.
(2) Can produce a copy of the FMCSRs and the Hazardous Materials Transportation Regulations.
(3) Has in place a driver safety training/orientation program.
(4) Has prepared and maintains an accident register
(49 CFR
390.15).
(5) Is familiar with DOT regulations governing driver qualifications and has in place a system for overseeing driver qualification
requirements
(49 CFR
391).
(6) Has in place policies and procedures consistent with USDOT regulations governing driving and operational safety of motor
vehicles, including drivers’ hours of service and vehicle inspection, repair, and maintenance
(49 CFR
392, 395, and 396).
(7) Is familiar with, and will have in place on the appropriate effective date, a system for complying with USDOT regulations
governing alcohol and controlled substances testing requirements
(49 CFR 382
and 40).
YES
31. EXEMPT APPLICANTS
If you will operate only small vehicles (GVWR under 10,000 pounds) and will not transport hazardous materials, you are exempt from
FMCSRs, and must certify as follows:
Applicant is familiar with and will observe general operational safety guidelines, as well as any State and local laws and requirements
relating to the safe operation of commercial motor vehicles and the safe transportation of hazardous materials.
YES
Section
5
AFFILIATIONS
32. AFFILIATIONS
Disclose any relationship you have or have had with any other FMCSA-regulated entity (including entities licensed by the FHWA,
OMCS, or ICC) within the past three years. Examples include, but are not limited to, a percentage of stock ownership, a loan, or a
management position. If this requirement applies to you, provide the name of the company, MC/FF Number, USDOT Number, and
that company’s latest DOT safety rating. If you require more space, attach the information to this application form.
ATTACH FILE
FORM OP-1 • Page 3 of 6
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