|
<br />OMB No. 2l2E-Q013
<br />
<br />o
<br />
<br />U,S Departmenl of Transportation
<br />Federal Motor Carrier
<br />Safety Administration
<br />REASON FOR FILING
<br />
<br />C NEW t-PPLlCATION
<br />
<br />(Check Only One)
<br />!19 BIENNIAL UPDATE OR CHANGES
<br />
<br />MOTOR CARRIER IDENTIFICATION REPORT
<br />(Application for U.S. DOT NUMBER)
<br />
<br />D OUT OF BUSINESS NOTIFICATION
<br />
<br />o REAPPLICATION (AFTER REVOCATION OF NEW EI<TRANT)
<br />
<br />2. TRADE OR D.B.A, (DOING BUSINESS AS) NAME
<br />
<br />I
<br />I
<br />I
<br />I
<br />
<br />8. ZIP CODE T 4
<br />! 33167
<br />
<br />13, PRINCIPAL BUSINESS PHONE r~UMBER
<br />I {305} 6B8~7700
<br />
<br />.15, USDOT NO, 17. MC OR MX NO,
<br />
<br />1203231 I MC476678
<br />
<br />:21. COMPANY OPERATION (Circle all that apply)
<br />@Interstale Caccier B, Intrastate Hazmat Carner C.lntrastate Non-Hazmat Carrier
<br />
<br />:22, CARRIER MILEAGE (to nearest 10,000 miles for Last Calendar Year)
<br />4836019
<br />
<br />.---:--:--1,i?~}I~~~TOR ...AEkl!:..R
<br />AMERICAN COACH LII~ES OF MIA.MIINC
<br />
<br />3. PRINCIPAL STREET ADDRESS/ROUTE NUlv1BER
<br />3595 NW 110 STREET
<br />
<br />I 7
<br />
<br />ST ATE/PROVINCE
<br />FLORIDA
<br />
<br />1 4. CITY 5. I~AILlNG ADDRESS (P 0 BOX)
<br />I MIAiI"l I 3595 NW 110 STREET
<br />
<br />19.COLONIA. (MEXICO ONLY) 110 STATE/PROVII;JCE
<br />I FLORIDA
<br />i 14. PRINCIPAL COIHACT CELLULAR PHONE ',UM8ER
<br />, (786) 367,9815
<br />'18. DUN & BRADSTREET NO. 1'19. IRSITAX ID NO.
<br />I ' EIN# 200187867
<br />
<br />I 6. MAILING CITY
<br />MIAMI
<br />
<br />'\11. ZIP CODE+4 r2.COLOI~IA (Iv1EXICO ONLY)
<br />33'167 I
<br />15. PRINCIPAL BUSII,ESS FAX NUMBER
<br />(305) 681-8'134
<br />120. INTERNET E-MAIL ADDRESS
<br />
<br />SSN#
<br />
<br />harold. young@coachamerica.com
<br />
<br />D. Interstate Shipper
<br />
<br />E, Intrastate Shipper
<br />
<br />F. Vehicle Registrant Only
<br />
<br />YEAR
<br />2010
<br />
<br />(Circle All that Apply)
<br />
<br />0, Private Passengers (Business)
<br />
<br />E. Private Passengers (Non-Business)
<br />
<br />F. Migrant
<br />
<br />123. OPERATION CLASSIFICATION
<br />
<br />o Authorized For-Hire
<br />
<br />I B. Exempt For-Hire
<br />
<br />I C. Private Property
<br />I
<br />
<br />!24. CARGO CLASSIFICATIONS
<br />i A.
<br />
<br />(Circle All that Apply)
<br />
<br />I
<br />IB
<br />
<br />GENERAL F, LOGS, POLES,
<br />FREIGHT BEAMS, LUMBER
<br />HOUSEHOLD G BUILDING
<br />GOODS r~A TERIALS
<br />r~ETAL: SHEETS; H, MOBILE HOMES
<br />COILS: ROLLS
<br />MOTOR VEHIC~=S MACHINERY,
<br /> LARGE OBJECTS
<br />
<br />C
<br />
<br />D.
<br />
<br />I
<br />I-
<br />I
<br />!25.
<br />I
<br />I
<br />
<br />G. U. S,lv1ail
<br />H. Federal Government
<br />I. State Government
<br />
<br />J. Local Government
<br />K, Indian Tribe
<br />L. Othe'
<br />
<br />J. FRESH PRODUCE
<br />
<br />P, GRAIN, FEED, HAY
<br />
<br />V, COMMODITIES DRY BULK
<br />
<br />BB, CONSTRUCTIOt-i
<br />
<br />K. LIQUIDS/GASES
<br />
<br />Q. COAL/COKE
<br />
<br />\IV, REFRIGERATED FOOD
<br />
<br />CC, WATER WELL
<br />
<br />L, INTERMODAL CONT.
<br />g PASSENGERS
<br />N. OIL FIELD EQUIPMENT
<br />
<br />R. MEAT
<br />
<br />X. BEVERAGES
<br />
<br />DD,OTHER
<br />
<br />S, GARBAGE, REFUSE, TRASH Y. PA?ER PRODUCTS
<br />
<br />T, U.S. MAIL
<br />
<br />z. UTILITY
<br />
<br />DRIVE o. LIVESTOCK U. CHEMICALS AA, FARM SUPPLIES
<br />AVIlA YiTOWAWA Y
<br />HAZARDOUS MATERIALS CARRIED OR SHIPPED (Circle All that Apply) C-CARRIED S-SHIPPED B(BULK) - IN CARGO TANKS NB(NON-BULK) - IN PACKAGE
<br />C S A. DIV 11 B NB C S K. DIV 2.21'. (Ammonia) B NB C S U. DIV 4.2 8 NB C S EE. HRCQ B NB
<br />C S g, DI\l1,2 B NB C S L. OIV 2.3A B NB C S V, DIV 4,3 B NB C S FF. CLASS 8 B NB
<br />C S C, DIV 1,3 B NB C S M, DIV 2.38 B N8 C S W. DIV 5.1 B NB C S GG. CLASS 8A B NB
<br />C S D. DIV 1.4 B NB C S N. DIV 2.3C B I>JB C S X. DIV 5.2 B NB C S HH, CLASS 8B B NB
<br />C S E, DIV 1,5 B NB C S 0, DIV 2.3D B NBIC S y, DIV 6.2 B NB C S II, CLASS 9 B NB
<br />C S F. DIV 1.6 B NB C S P. Class 3 B NB C S Z.DIV6.1A B NB C S JJ. ELEVATED TEIv1P I",AT. B NB
<br />C S G. DIV 21 B NB C S Q, Class 3A B NBIC S AI'., DIV 6.1B 8 NB C S KK. INFECTIOUS WASTE B NB
<br />C S H,DIV2.1 LPG B NB C S R. Class 3B B NBjC S BS, DIV 6.1 Poison B NB C S LL. MARINE POLLUTAI>JTS 3 I,S
<br />C S I. DIV 2.1 (Methane)B NB I C S S, COM L1Q 8 NB C S CC, DIV 6.1 SOLID 6 NB C S MM, HAZARDOUS SUB(RQ) B NB
<br />C S J. DIV 2,2 B NB I C S T. DIV4.1 B NB C S DD. CLASS 7 B NBlc S NN. HAZARDOUS WASTE B NB
<br /> C S OO.ORM B NB
<br />
<br />I
<br />26. NUIv1BEOR OF VEHICLES THAT CAN BE OPERATED II>J THE U S
<br />
<br /> I i I I I : I I i
<br /> I Straight Truck Trailers I Hazmat i Hazmat Cargo Motor 1 School Bus lv1ini-bus I Van I limOUSine
<br />I I ! ,
<br />I Trucks Tractors I I Cargo I Tank Trailers Coach
<br />! I I Number of vehicles carrying number of passengers (including the driver) below
<br />I I Tank Trucks
<br /> I I I I 1-8 I 9-15 16~ I 16+ I 1-8 I 9-15 I 1-8 I 9-15 16+ I
<br />10WNED I I i I I 1011 I I 321 I I I I
<br />~ASED I I I I I I I 1 I I I I I
<br />'TRIP LEASED ; I I I I I I I I I I I I
<br />127 DRIVER II.FORMATION I INTERSTATE I INTRASTATE I TOTAL DRIVERS I TOTAL CDL DRIVERS I
<br />I Within 1 OO-Mile Radius I 0, 0 144 144.
<br />I 8eyond 1 OO-Mile Radius l 1441 0, J I
<br /> I
<br />128. IS YOUR U.S. DOT NUMBER REGISTRATION CURRENTLY REVOKED BY THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION? Yes - r~o X I
<br />I If Yes, enter your U.S. DOT Number.
<br />
<br />1. BRET BRITTENUrVi, V.P. & GEI-JERAL MANAGER
<br />(Please print Name)
<br />
<br />129 PLEASE ElnER NAME(S) OF SOLE PROPRIETOR(S), OFFICERS OR PARmERS Ai<D TITLES (e.g. PRESIDENT. TREt-SURER, GENERAL PARTNER, LlllolTED PARTl-JER)
<br />
<br />I
<br />!
<br />
<br />(Please print Name)
<br />
<br />2.ROE FINKE. REGIONAL VICE PRESIDENT
<br />
<br />(Please print r,ame)
<br />
<br />'30. CERTIFICA TIOl< ST A TEII.EIH (to be completed by an authorized official)
<br />!. HAROLD YOUNG
<br />
<br />,certify that I am familiar with thE r=ederai MotOi Carrier Safely Regulations and/or Federal HazarClous Materials Regulations
<br />Under penalties of perjury, I declare that tne information entered on thi~ report is, to the best of my knowledge and belief, true,
<br />correct. and complete.
<br />
<br />Dale 05/19/20'1 'I
<br />
<br />SlgnalorE HAROLD YOUI~G
<br />
<br />Form MCS-150 (Rev. 3-24-2005)
<br />
<br />DIRECTOR OF SAFETY
<br />Title
<br />
<br />(Please nrintl
<br />E):piration Date: 03/3'1/20'1 'I
<br />
|