Attachment 5_DLA Form 2503 Apply for QTL.pdf

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PDF (DLA)

DLA FORM 2503, MAR 2022

APPLICATION FOR QUALIFIED TRANSPORTER LIST (QTL)

Prescribed by: DLAI 4140.12 Sponsor: Disposition Services

PREVIOUS EDITIONS OBSOLETE

8. REGULATORY AND FINANCIAL ASSURANCE

REQUIREMENT

SUBMITTED

APPLICANT COMMENTS

A. Does the carrier have a Federal Motor Carrier Safety Administration(FMCSA) or State DOT rating of satisfactory or equivalent?

B. Has the carrier had any hazardous materials incidents within the last three years? If yes,provide enforcement agency copies of the hazardous materials incident report.

C. Does the carrier maintain general, property, bodily injury, and pollution liability insurance coverage(maritime insurance if applicable)? If no, please explain. If yes, provide copy of insurance certificates.

D. Are all loads transported by the carrier using owned/leased vehicles? If no, submit DLA Form (2503) and all required documentation for additional contracted transporters.

E. Will carrier be providing transportation services using marine vessels? If yes, provide copies of training and proof of IMDG notification if applicable.

F. Will carrier be required to transport material outside of the United States or is this an overseas transporter? If yes provide list of countries and submit foreign country license documentation.

G. If the carrier is authorized to to transport hazardous material/hazardous waste, provide latest DOT Hazardous Material Certificate of Registration or country equivalent.

H. Current carrier POC with phone number and e-mail address.

I. Name, company, phone number, and email address of POC submitting this request.

APPLICANT INSTRUCTIONS

Transporter Name Provide name of carrier as it is assigned on any regulatory permits. Designate if using a dba.

Transporter EPA I.D. Number Provide assigned US EPA I.D. number if the carrier is in the USA. If the carrier does not have a US EPA I.D. or an assigned transporter I.D. number from DLA, leave blank.

Transporter Address List the carrier's complete address.

Transporter USDOT Number This number will be an assigned registration number with the United States Department of Transportation.

DLA Prime Contractor Name Provide the current DLA prime contractor's company name.

Contract Number Provide the contract number that the DLA prime contractor is working under for waste that would be shipped using this carrier.

Regulatory and Financial Assurance Many of the requirements in this section are designed for carriers located in the USA. If the carrier is located outside the USA and the regulatory system does not support the requirement, please indicate so in the comments box. Do not leave a requirement unanswered and always provide the supporting documentation where requested. Not providing the requested information and supporting documentation will slow down the review process and may result in a rejection.

Application Submitter Print name and contact information of carrier representative completing the application. The application will not be accepted without this information. Once the form is complete, submit it to the DLA Disposition Services by clicking on the "Submit Form" link at the top of the form.

11. DLA USE ONLY - VERIFICATIONS AND QFL RECOMMENDATION

CLAUSE

RESULTS

VERIFIER COMMENTS

A. Has the Contractor submitted all required documentation and information?

B. SAFER report reviewed?

C. Has the carrier exhibited a history of safety or hazardous material incidents?

12. RECOMMENDATION

After conducting the review and verifying documentation, I recommend the following:

AS THE VERIFIER, I CERTIFY THAT THE INFORMATION PROVIDED ON THIS FORM IS TRUE AND CORRECT.

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MONTH 2014