Form Op-1 - Application For Motor Property Carrier And Broker Authority Page 9

Download a blank fillable Form Op-1 - Application For Motor Property Carrier And Broker Authority in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Op-1 - Application For Motor Property Carrier And Broker Authority with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

INSTRUCTIONS OP-1 Revised 01/10/2017
OMB No.: 2126-0016 Expiration: 01/31/2020
SECTION 4 — SAFETY CERTIFICATION
Only applicants that will operate commercial motor vehicles must complete this section. Select only one response.
30-31. Safety Certification —
Applicants that will only operate vehicles with a GVWR under 10,000 pounds and will not transport
hazardous materials are exempt from the Federal Motor Carrier Safety Regulations. Skip to the paragraph “EXEMPT APPLICANTS, ” read
the corresponding statement, and select the “YES” response in this part only if the applicant attests that the entire statement is true.
All other applicants that will operate vehicles with a GVWR of more than 10,000 pounds must read the statements under
“APPLICANTS SUBJECT TO FEDERAL MOTOR CARRIER SAFETY REGULATIONS. ” These statements describe the activities that Motor
Carriers and U.S.-based Enterprise Carriers must follow in order to comply with the FMCSRs. Select the “YES” response in this part only
if the applicant attests that all of the statements are true.
SECTION 5 — AFFILIATIONS
Only applicants with any relationship within the past 3 years to any business entity regulated/licensed by the FMCSA, ICC, FHWA,
or OMCS must complete this section.
32. Affiliations —
Examples of an affiliation or relationship include, but are not limited to, owning another company (even a
percentage of stock), providing a loan to another company, managing another company, or having a family relationship with an
owner or manager of another company.
Disclose any past or current relationship within the last 3 years by providing the following:
• Description of affiliation or relationship.
• Name of the company.
• MC/FF Number.
• USDOT Number.
• Latest DOT safety rating (for more information, see
“Information
Sources” [Topic VI] in this packet).
SECTION 6 — HOUSEHOLD GOODS CERTIFICATIONS
Only companies applying for Operating Authority as a Motor Common Carrier of Household Goods, Motor Contract Carrier of
Household Goods, Broker of Household Goods, or United States-based Enterprise Carrier of International Household Goods must
complete this section.
33-35. Household Goods Certifications —
Select the applicable paragraph(s) depending upon the type(s) of Operating Authority
requested in
“Section 2 − Type of Operating
Authority” of the application form. Read the corresponding statement(s) and select the
corresponding “YES” response(s) if the entire statement is true.
SECTION 7 — SCOPE OF OPERATING AUTHORITY
36-37. —
Only companies applying for Operating Authority as a Motor Contract Carrier of Household Goods must complete this
section.
SECTION 8 — APPLICANT’S OATH
All applicants must complete this section. False certifications are subject to the penalties described in the oath.
38. Applicant’s Oath —
Type or print the name and title of an individual authorized to sign documents on behalf of the company
that is applying for Operating Authority. The authorized signer is one of the following:
• In the case of a sole proprietorship, the owner.
• In the case of a partnership, an official partner.
• In the case of a corporation, an authorized employee in the ownership structure.
• An individual with power of attorney to act on behalf of the applicant (proof of the power of attorney must be submitted with
the application).
NOTE: If this application is not signed and dated by an authorized individual, the application will be rejected and Interstate Operating Authority will NOT
be issued.
INSTRUCTIONS OP-1 • Page ix of x

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal