Blank Chp 362 Template

Detailed instructions begin on page 3.

Driver license numbers, Social Security Numbers (SSN), California corporation numbers, and Federal Employer Identification Numbers (EIN) are used to prevent misidentification with other persons or organizations with similar names. In the case of an organization which is a "motor carrier of property" as defined in Vehicle Code (VC) Section 34601, some of the information supplied on this profile will be shared with the Department of Motor Vehicles (DMV). The California Highway Patrol (CHP) is prohibited from issuing more than one CA number to a person, regardless of how many "Doing Business As" names the person may have.

The CHP recommends that upon completion of this Motor Carrier Profile, you make a copy for your records prior to mailing the original to the CHP.

Mail completed Motor Carrier Profile to your nearest CHP Motor Carrier Safety Unit (MCSU). If you received special instructions to mail this profile to another CHP office, please mail as requested in those instructions (see page 3 for addresses).

PART 1. LEGAL NAME Complete for Individual, Partnership, Corporation or Limited Liability Company (one only)

Partnership

Corporation (Public agencies and non-profit organizations, check this box whether incorporated or not)

State or Local Government Agency

Non-Profit Organization (Check only if qualified for tax exemption under Section 501(c) of the Internal Revenue Code.)

Limited Liability Company (LLC) (Registered with the California Secretary of State)

Corporation, Partnership, or Certificate of Qualifications No. issued by California Secretary of State:

Letter ◄ Numbers only ►

Limited Liability Company Entity Number assigned by the California Secretary of State:

PART 3. EMERGENCY CONTACTS

Persons the CHP should attempt to contact in the event of an emergency involving one of your organization's vehicles or drivers.

PART 4. TYPES OF OPERATION (Check all that apply. This will assist CHP in mailing new information to your organization only when appropriate.)

IMPORTANT! Read the descriptions of each item beginning on pages 4 and 5 before checking the box.

PART 5. DOING BUSINESS AS (DBA) (Fictitious Business Name on file with the County or California Secretary of State.)

Doing business in California as

Doing business in California as

Doing business in California as

PART 6. OPERATING AUTHORITIES AND IDENTIFICATION NUMBERS

PART 7. CALIFORNIA TERMINALS (Attach additional pages if necessary; provide the same information for each terminal)

If the CHP needs to clarify any of the information your organization has provided, who should be contacted by telephone for assistance?

Date this Carrier Profile was prepared (information current as of):

DIRECTIONS FOR COMPLETING

CHP 362, MOTOR CARRIER PROFILE (Rev. 3-18)

CA - If your company already has a CA number issued by the CHP, enter it in the box at the top of page 1 and check the box labeled “Update.” Display of a CA number on commercial motor vehicles is required only under specified circumstances. If you are unsure whether your company already has a CA number, contact the nearest CHP MCSU, listed below.

PART 1. LEGAL NAME: One choice only - check Individual, Partnership, Corporation (which includes associations, trusts, and public agencies), or Limited Liability Company. Often, trusts hold property but do not operate businesses. Therefore, even if your company's assets are held by a trust but the company remains the motor carrier, enter the ownership information of the company under one of the four categories below.

INDIVIDUAL: If operating as an individual (sole proprietorship) with or without employees. If you have no EIN, enter the individual's SSN. Check the appropriate box to indicate EIN or SSN. A valid driver license number and issuing state are required. The application will not be processed without one. A valid California identification card number issued by the DMV is acceptable in lieu of a driver license number.

Please enter your proper legal name, not a nickname.

PARTNERSHIP: All requested information is required to prevent duplication of records. Businesses held as community property and operated jointly by family members (husband and wife, parent and child, etc.) are not partnerships unless legally organized as such, with an EIN assigned to the partnership. If not legally organized as a partnership, enter as an individual under one person's name and follow instructions outlined above for an individual.

CORPORATION: All requested information is required, to prevent duplication of records. Corporation number is normally stamped on an upper corner of Articles of Incorporation in California. If a foreign corporation, the Certificate of Qualifications number issued by the California Secretary of State is required instead. Information regarding legal status as a state or local government agency, or as a non- profit organization under federal regulations, is requested to prevent misdirected mailings and misapplication of motor carrier safety regulations, requirements for licenses, or fees for various related programs.

LIMITED LIABILITY COMPANY: All requested information is required, to prevent duplication of records. Include the Limited Liability Company number assigned by the California Secretary of State and the assigned EIN.

PART 2. PRINCIPAL PLACE OF BUSINESS: A single location designated by the motor carrier, normally its headquarters, where records required by federal motor carrier safety regulations will be maintained, if applicable, and records of drug and alcohol testing required by Section 34520 of the VC will be made available for inspection. The telephone number should be the normal daytime business number for the company. The principal place of business may be outside of California. Provision is made elsewhere on the Motor Carrier Profile for emergency and other telephone numbers. Do not write in the box marked "CHP USE ONLY".

FLEET MILEAGE IN CALIFORNIA: All mileage accumulated in California by vehicles identified in Part 4 during the most recent full calendar year, whether operated in intrastate or interstate service. For this purpose there is no need to separate intrastate mileage from total in-state mileage (some of which could be part of interstate trips), as it will be used by the CHP solely for safety regulation purposes.

PART 3. EMERGENCY CONTACTS: Enter the names of responsible individuals at the company-wide level of your organization whom the CHP should attempt to contact in the event of an emergency involving your organization's vehicles or drivers. These should be management or supervisory personnel, as they may receive information requiring confidential handling within your firm or organization. Do not include a telephone number if its use requires a Personal Identification Number or other access information, as the CHP's system has no means to store that additional information. Please notify your nearest MCSU (page 3) immediately of any permanent changes in personnel who are on-call for emergencies involving CHP-regulated commercial motor vehicles. Your organization can also designate two emergency contacts for each California terminal listed in Part 7 by notifying your local MCSU in writing. In doing so, identify two persons or offices with a day and night telephone number for each. Emergency circumstances may not always result in CHP using this source of information to contact your organization, but keeping this information current is strongly recommended. This is also a reason to ensure the identification numbers in Part 6 are accurate and complete, and represent your organization, not one to which you may be leased or contracted.

PART 4. TYPES OF OPERATION:

A.Truck - Any truck of three or more axles with a gross vehicle weight rating (GVWR) of more than 10,000 pounds; any truck tractor regardless of number of axles or GVWR; and any truck used to tow a trailer where the overall length of the truck and trailer coupled together exceeds 40 feet.

B.Hazardous Materials Carrier - Any truck, including pickups, used to transport any amount of hazardous materials.

C.Hazardous Materials Shipper - An individual or company who offers hazardous materials for transportation by common carrier, contract carrier, or motor carrier of property, and never transports hazardous materials in any amount on vehicles owned, rented, leased, or otherwise controlled or operated by the shipper.

D.Hazardous Waste Transporter - An individual or company that transports hazardous wastes as defined in California or federal regulations.

E.Flammable Liquid Cargo Tank - Any tank greater than 120 gallons capacity which is used to transport liquids having a flash point of less than 100 degrees Fahrenheit, other than in the regular fuel tank of the vehicle.

F.Bus Without Operating Authority - Any vehicle of more than ten passenger capacity including the driver; the operation of which does not require a certificate, permit, or authority issued by the California Public Utilities Commission (PUC), or the Federal Motor Carrier Safety Administration (FMSCA). This typically includes, but is not limited to, church or other private buses; and public transit buses operated by city or county transit agencies.

G.Tour Bus - Any bus subject to regulation of; and requires a certificate, permit, or authority issued by; the PUC or the FMSCA.

H.School Bus - The traditional yellow school bus specifically certified by the CHP for transportation of school pupils attending public or private schools.

I.School Pupil Activity Bus - A commercial or transit bus specifically certified by the CHP for use in transporting school pupils on school-sanctioned trips to or from school-related activities under specified conditions, but not including home-to-school or school-to-home route service.

J.Youth Bus - A small bus specifically certified by the CHP for service in transporting school pupils between school and non-school related activities.

K.General Public Paratransit Vehicle - A vehicle operated by or under contract to a transit agency in dial-a-ride, subscription, or route- deviated service; and certified specifically by the CHP for transportation of school pupils to and from schools.

L.Farm Labor Vehicle - A passenger vehicle or truck specifically certified by the CHP for use in transporting farm laborers.

M.Vehicle or combination described in Section 34500(k) VC - Any commercial motor vehicle with a GVWR of 26,001 or more pounds; or any combination of vehicles consisting of a commercial motor vehicle of any GVWR and a trailer with a gross weight or GVWR greater than 10,000 pounds ("Trailer" for this purpose does not include camp trailers, trailer coaches, or utility trailers).

N.Vehicle described in Section 34500(j) VC - Any other motor truck not described in A, B, D, E, or M above; the operation of which is subject to regulation by the DMV through the Motor Carrier of Property Permit requirements, the PUC, or United States Department of Transportation.

O.Modified Limousine - Any vehicle operated for-hire by a charter-party carrier of passengers or a passenger stage corporation which seats not more than ten passengers including the driver, and has been modified, altered, or extended in a manner that increases the overall wheelbase of the vehicle, exceeding the original equipment manufacturer's published wheelbase for the base year and model of the vehicle, in an amount sufficient to accommodate additional passengers.

PART 5. DOING BUSINESS AS (DBA): Enter all lawfully registered business names used in California by this entity (businesses not involving the use of regulated vehicles in Part 4 may be excluded). A company, which is a different legal entity and assigned a separate EIN, requires its own CA number and Motor Carrier Profile. Employer Identification Numbers are requested solely to positively identify separate entities and not for any purpose relating to tax issues. Organizations sharing the same EIN shall share the same CA number, although they may continue to be identified by separate DBA names.

PART 6. OPERATING AUTHORITIES AND IDENTIFICATION NUMBERS: Certain types of carriers are not required to display their assigned CA number if they are already displaying valid numbers assigned to them by other specified regulatory agencies. In order to cross reference your organization's other numbers to its CA number, the CHP needs to know what the other numbers are. US DOT: The number assigned by the FMCSA and displayed on vehicles as "USDOT 000000". This number is not the same thing as the docket or ICC number. Many commercial motor vehicle operators have both numbers, and should list both in this Part. The US DOT number is required for all California motor carriers per Section 34507.5 VC. MC: The number assigned to your organization by the FMCSA. This number is often shown on documents as "MTR 000000," and on vehicles as "MC 000000" with the zeros replaced by the number assigned to the company. Do not list a number that is assigned to a motor carrier to which your vehicle is leased or to which your company is subcontracted. MX: Similar to MC numbers, but are assigned to carriers based in Mexico and operating in the United States. Cal-T: The number assigned to California intrastate household goods carriers by the PUC. Cal-T numbers are no longer valid for any type of motor carrier other than household goods carriers. PSG: A number assigned by the PUC to intrastate for-hire passenger carriers (other than taxi services), which are preceded by the prefix "TCP" or "PSC," displayed on vehicles as "TCP 00000A" or "PSC 00000" (or both) with the zeros representing the number assigned to the carrier by the PUC, and the "A" representing a PUC-assigned alphabetic character indicating a specific type of passenger carrier. IRP: The International Registration Plan identification number assigned by the appropriate agency in your state (DMV for California-based carriers).

PART 7. CALIFORNIA TERMINALS: All business locations from which vehicles described in Part 4 are dispatched or operated in intrastate service, or in initiating, completing, or continuing the movement of an interstate load. It may include facilities owned by another business, such as a warehouse to or from which loads are transported and where the commercial motor vehicle is normally parked when not in use. "Terminal" may also include the private residence of an owner-operator or other small business utilizing commercial motor vehicles, if that is where the organization conducts business.

Terminal DBA and Address: A properly registered DBA name used at that location, if different from the name identified in Part 1, and the

physical address of each location. City Name: City or community name only. State is not necessary, as only locations within California

must be listed. Zip Code: The postal zip code of the terminal's physical location, whether or not the company receives mail there. Phone

Number: The telephone number at which management personnel for that terminal can be contacted during normal business hours. The CHP uses this information to determine which CHP office serves that area.

Driver Records? - Check "Y" if records relating to commercial motor vehicle drivers are kept at this location, such as driver qualification files, DMV driving records, and drivers' time records. Check "N" if this location is not where such records are kept.

Vehicle Records? - Check "Y" if commercial motor vehicle inspection and maintenance records are kept at this terminal for the vehicles based there, such as drivers' daily vehicle inspection reports, company safety inspection records, scheduled maintenance records, repair records. Check "N" if this location is not where such records are kept.

CHP USE ONLY: The CHP uses this column to add geographical coding to indicate this terminal's location.

The ultimate goal of the CHP's inspection programs is the reduction of human suffering and property loss resulting from commercial motor vehicle at-fault accidents. This Motor Carrier Profile is an important tool in the CHP's effort to direct inspection resources where they are needed most, and to reduce the cost of regulation to both the regulated community and the state. Although it is detailed, time spent now in completing it carefully will be repaid by allowing the CHP to correctly identify entities to which mailings should be directed, to quickly notify your organization of an emergency involving your commercial vehicles or drivers, and to identify entities which require more or less contact from the CHP, depending on the nature of their businesses and their safety experiences over time.