Attachment 8_DLA Form 2503 Transporter Qualification.pdf
PDF 188 KB Posted
- Attached to
- United Kingdom Hazardous Waste Disposal
- Solicitation number
- SP450026R0007
- Issued by
-
Defense Logistics Agency
About this file
This is a Transporter Qualification Review Application form used by the Defense Logistics Agency (DLA) to evaluate and approve transporters for waste management and logistics services. The form is prescribed under DLA regulation 4160.14 and sponsored by Disposition Services.
The application requires transporters to provide comprehensive company information including their name, 12-digit ID number, and address, along with primary waste transporter permit numbers. For motor carriers operating in the continental United States (CONUS), applicants must submit their Federal Motor Carrier Safety Administration (FMCSA) USDOT number, most recent FMCSA audit date, and documentation of any federal or state safety violations within the past three years. Additionally, carriers must disclose any traffic citations or hazardous materials incidents from the prior three years and provide their current Office of Motor Carrier Safety (OMCS) or State Department of Transportation rating.
The Risk Mitigation section requires applicants to confirm whether their company maintains a written hazardous materials safety training program and current general, property, bodily injury, and pollution liability insurance coverage, with supporting documentation required for affirmative responses. Applicants must also specify whether all transported loads use company-owned or leased vehicles, and if contractors are used, those contractors must meet identical DLA approval criteria. The form requires disclosure if the carrier will use marine vessels for transportation, which necessitates International Maritime Dangerous Goods (IMDG) transportation licenses. Finally, CONUS carriers must indicate whether they will transport materials outside the continental United States or are overseas transporters, and if so, must provide a list of countries and submit foreign country license documentation. The application concludes with company representative information and a DLA verifier certification section.
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Text version
TRANSPORTER QUALIFICATION REVIEW APPLICATION Prescribed by: DRMS I 4160.14 Sponsor: Disposition Services
Instructions: Please complete form electronically and save file using name of carrier.
1. Transporter Name: 2. Transporter 12 Digit I.D. Number (if applicable):
Instructions: Complete all sections and provide backup documentation 3. Transporter Address:
where requested. If the requested information is not applicable, please identify as N/A.
4. List primary waste transporter permit numbers:
Motor Carrier Safety (CONUS Only)
5. Federal Motor Carrier Safety Administration (FMCSA) USDOT Number: 6. FMCSA audit date:
7. List dates, city and state location of any Federal or State safety violations in the last 3 years:
8. Has the company had any traffic citations or hazardous materials incidents within the last three years?
Yes No
If yes, provide enforcement agency copies of traffic citations or hazardous materials incident report.
9. Provide current Office of Motor Carrier Safety (OMCS) or State DOT rating:
Risk Mitigation
10. Does company have a written hazardous materials safety training program?
Yes No
If yes, provide a copy of the training program.
11. Does company maintain general, property, bodily injury and pollution liability insurance coverage?
Yes No
If yes, provide copy of insurance certificates.
12. Are all loads transported by company owned/leased vehicles? Yes No
If no, all contractors must meet same criteria to qualify as a DLA approved transporter.
13. Will carrier be providing transportation services using marine vessels? Yes No
If question 13 was yes, carrier is required to submit International Maritime Dangerous Goods (IMDG) transportation licenses.
14. Will CONUS carrier be required to transport material outside the continental United States or is this an overseas transporter?
If yes to question 14, provide list of countries below and submit foreign country license documentation. Yes No
Company Representation
15. Name of representative completing application: Date:
16. Phone number and e-mail of primary contact person for transporter:
For DLA Use Only As the verifier, I certify that the information provided on this form is true and correct.
NAME OF DLA VERIFIER: VERIFIER SIGNATURE & DATE:
DLA FORM 2503, SEP 2016 PDF (DLA)
| Motor Carrier Safety (CONUS Only) |
| Risk Mitigation |
| Company Representation |
| For DLA Use Only |
| DLA FORM 2503, SEP 2016 |
| 1 Transporter Name: |
| 2 Transporter 12 Digit ID Number if applicable: |
| Instructions Complete all sections and provide backup documentation 3 Transporter Address: |
| 4 List primary waste transporter permit numbers: |
| 7 List dates city and state location of any Federal or State safety violations in the last 3 years: |
| NAME OF DLA VERIFIER: |
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| Date6_af_date: |
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File details come from the government source that posted it. Updated .