Attach 14 - DLA Form 2503 -TQL Application.pdf

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TRANSPORTER QUALIFICATION REVIEW APPLICATION

Prescribed by: DRMS I 4160.14 Sponsor: Disposition Services

PDF (DLA)

DLA FORM 2503, JAN 2016

Smith, William R Smith - Defense Logistics Agency 10.0.2.20120224.1.869952 Instructions: Complete all sections and provide backup documentation where requested. If the requested information is not applicable, please identify as N/A.

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

4. List primary waste transporter permit numbers:

Motor Carrier Safety (CONUS Only)

8. Has the company had any traffic citations or hazardous materials incidents within the last three years?

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

Risk Mitigation

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

If yes, provide a copy of the training program.

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

If yes, provide copy of insurance certificates.

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

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?

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.

Company Representation

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.