Attachment_4b_Transporter_Qualification_Review_Application.pdf

Transporter Qualification Review Application

1. Transporter Name:

2. Transporter Address:

Instructions: Complete all sections and provide backup documentation where requested. If the requested information is not applicable please identify as N/A.

3. Transporter EPA I.D. Number:

4. List primary state waste transporter permit numbers:

Motor Carrier Safety

5. Federal Motor Carrier Safety

Administration (FMCSA) USDOT Number:

6. FMCSA audit date:

Click here to enter a date.

Provide audit report from regulatory agency.

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? Choose an item.

If yes, provide enforcement agency copies of traffic citations or hazardous materials incident report.

9. Provide current Office of Motor Carrier Safety rating (OMCS) Carriers must have an OMCS rating within the last 3 years to qualify.

Risk Mitigation

10. Does company have a written hazardous materials safety training program?

Select an item.

If yes, provide a copy of the training program.

11. Does company maintain general, property, bodily injury and pollution liability insurance coverage?

Select an item.

If yes, provide copy of insurance certificates.

12. Are all loads transported by company owned/leased vehicles? Choose an item.

If no, all contractors must meet same criteria to qualify as a DLA approved transporter.

13. List company names and city location below for all contract carriers.

14. Will carrier be providing transportation services using marine vessels?

Select an item.

Carrier Name City Location

If question 14 was yes, carrier is required to submit International Maritime Dangerous Goods (IMDG) transportation licenses.

15. Will carrier be required to transport material outside the continental United States? Choose an item.

If yes to question 15, provide list of countries below and submit foreign country license documentation.

Click to select country/state. Click to select country/state.

Company Representation

16. Name of representative completing application: Click here to enter a date.

17. Phone number & email of primary contact person for transporter:

Please complete form electronically and save file using name of carrier.

Solicitation SP4520-17-R-0001 (Attachment 4b)