Proposed Form OP-1MX - Federal Motor Carrier Safety ...

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BUSINESS ADDRESS: (Actual Street Address): _______________________________________________________________ (Street Name and Number) _______________________________________________________________ (City) (State) (Country) (Zip Code) (Colonia) (_______)________________ (_______)________________ (Telephone Number) (Fax Number) MAILING ADDRESS: (If different from above) _______________________________________________________________ (Street Name and Number) ________________________________________________________________ (City) (State) (Country) (Zip Code) (Colonia) U.S. ADDRESS: (Does the applicant currently have an office in the United States? If yes, give address and telephone number.) (Street Name and Number) ______________________________________________________________ (City) (State) (Country) (Zip Code) (_______)________________ (_______)________________ (Telephone Number) (Fax Number) APPLICANT’S REPRESENTATIVE: (Person who can respond to inquiries) Form OP-2 Revised March 2002 (Name and title, position, or relationship to applicant) (Street Name and Number) ______________________________________________________________ (City) (State) (Country) (Zip Code) (Colonia – Mexican addresses only) (_______)________________ (_______)________________ (Telephone Number) (Fax Number) U.S. DOT NUMBER (If available) _____________________________________ 56
FORM OF BUSINESS (Check one) ? CORPORATION (Give Mexican or U.S. State of Incorporation) _________ ____________________________________________________ ? SOLE PROPRIETORSHIP (Give full name of individual) Form OP-2 Revised March 2002 ________________________________________________________ (First Name) (Middle Name) (Surname) ? PARTNERSHIP (Give full name of each partner)______________________ ________________________________________________________ SECTION IA – ADDITIONAL APPLICANT INFORMATION 1. Does applicant currently operate in the United States? ? Yes ? No 1a. If yes, indicate the locations where applicant operates and the ports of entry utilized. ______________________________________________________ ______________________________________________________ ______________________________________________________ 2. Has the applicant previously completed and submitted a Form MCS-150? ? Yes ? No 2a. If yes, give the name under which it was submitted. ______________________________________________________ ______________________________________________________ 57
Page 1 and 2: U.S. Department of Transportation F
Page 3 and 4: • Use the attachment pages includ
Page 5 and 6: SPECIFIC INSTRUCTIONS FOR COMPLETIN
Page 13: U.S. Department of Transportation F
Page 17 and 18: 4. Does the applicant hold a Federa
Page 19 and 20: SECTION IV - INSURANCE INFORMATION
Page 21 and 22: Mexican safety regulations, and a d
Page 23 and 24: The carrier will ensure, once opera
Page 25 and 26: 7A. For Cargo Tank (CT) Carriers (o
Page 27 and 28: ATTACHMENT FOR SECTION V, NO. 1, DR
Page 29 and 30: ATTACHMENT FOR SECTION V, NO. 3, DR
Page 31 and 32: Form OP-2 Revised March 2002 ATTACH
Page 33 and 34: ATTACHMENT FOR SECTION V, NO. 6, PR
Page 35 and 36: Form OP-2 Revised March 2002 ATTACH
Page 37 and 38: Applicant is not prohibited from fi
Page 39: FILING FEE INFORMATION All applican

Proposed Form OP-1MX - Federal Motor Carrier Safety ...

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