Form Op-1 - Application For Motor Property Carrier And Broker Authority - U.s. Department Of Transportation Page 15

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OMB No. 2126-0016

Insurance Information

SECTION III

Applicants that will operate commercial motor vehicles must complete this section.

The dollar amounts in parentheses represent the minimum amount of bodily injury and property damage (liability) insurance coverage you must maintain and have on

file with the FMCSA.

NOTE: Refer to the instructions for information about cargo insurance requirements for motor common carriers and United States-based enterprise carriers, and surety

bond/trust fund agreement filings for brokers.

Applicant will operate any vehicle having a gross vehicle weight rating (GVWR) of 10,000 pounds or more to transport:

Non-hazardous commodities ($750,000)

Hazardous materials referenced in the FMCSA’s insurance regulations at 49 CFR 387.9 ($1,000,000)

Hazardous materials referenced in the FMCSA’s insurance regulations at 49 CFR 387.9 ($5,000,000)

Applicant will operate only vehicles having gross vehicle weight ratings (GVWR) under 10,000 pounds to transport:

Any quantity of Division 1.1, 1.2, or 1.3 material; any quantity of Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; or

highway route controlled quantities of a Class 7 material as defined in 49 CFR 173.403 ($5,000,000)

Commodities other than those listed above ($300,000)

SECTION IV

Safety Certification (for vehicle-operating applicants only)

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 U.S. DOT’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 U.S. DOT regulations relating to the safe operation of commercial vehicles and the safe transportation

of hazardous materials and it 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 Part 390.15);

(5)

Is familiar with DOT regulations governing driver qualifications and has in place a system for overseeing driver qualification requirements (49 CFR Part 391);

(6)

Has in place policies and procedures consistent with DOT regulations governing driving and operational safety of motor vehicles, including drivers’ hours

of service and vehicle inspection, repair, and maintenance (49 CFR Parts 392, 395, and 396);

(7)

Is familiar with and will have in place on the appropriate effective date, a system for complying with U.S. DOT regulations governing alcohol and controlled

substances testing requirements (49 CFR Part 382 and 49 CFR Part 40).

YES

EXEMPT APPLICANTS

If you will operate only small vehicles (GVWR under 10,000 pounds) and will not transport hazardous materials, you are exempt from Federal Motor Carrier Safety

Regulations, and must certify as follows:

Applicant is familiar with and will observe general operational safety guidelines, as well as any applicable State and local laws and requirements relating to the safe

operation of commercial motor vehicles and the safe transportation of hazardous materials.

YES

Affiliations

SECTION V

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 3 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.

2 / 4

Form OP-1

(Revised 8/14/2007)

Expiration Date 1/8/2010