Fillable Compliance Enforcement Division Emission Control Program 555 Wright (Department of Motor Vehicles )

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Compliance Enforcement Division Emission Control Program 555 Wright (Department of Motor Vehicles )

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Compliance Enforcement Division
Emission Control Program
555 Wright Way
Carson City, Nevada 89711-0250
Reno/Sparks (775) 684-3580
Las Vegas (702) 486-4981
Carson City (775) 684-4790
dmvnv.com
EC- 27 (Rev. 12/2016)
Page 1 of 2
APPLICATION FOR PARTICIPATION & MEMORANDUM OF UNDERSTANDING
NRS 445B.705
Business Name
FEIN
Station Name
Physical Address
Street
City
State
Zip
Mailing Address
Street
City
State
Zip
Email Address
Business Phone No (
)
-
Other Business Phone Number. (
)
-
Fax Number (
)
-
Internet Service Provider
Principals Name(s)
Station Contact Name
1. New application
Yes
No
If Yes, list all employees to receive manager access below.
2. Update to existing emission station
Yes
No
If Yes, list additional new managers, and list managers to be deleted ONLY.
The below listed Principal, Manager or Inspector is being granted access to the Vehicle Information
Database (VID) only.
Principal, Manager
or Inspector Name
Station
License
Number
Date of
Birth
Nevada
Drivers
License
Number
Inspector
License
Number (if
applicable)
Nevada
Resident,
Yes/No
Add or
Delete
Manager
Compliance Enforcement Division
Emission Control Program
555 Wright Way
Carson City, Nevada 89711-0250
Reno/Sparks (775) 684-3580
Las Vegas (702) 486-4981
Carson City (775) 684-4790
www.dmvnv.com
EC- 27 (Rev. 12/2016)
Page 2 of 2
Subscribed and sworn before me this
day
Application Accepted By:
Reviewed By:
Approved:
Yes
No
Reason for Denial
of
,20
Notary Public or Authorized Nevada DMV Representative
CUSTOMER RESPONSIBILITIES
1. Should any unauthorized user obtain access to the designated analyzer(s), customer must
notify their local DMV Emissions Lab immediately. Until such notification is made, customer
understands and agrees that they (customer) will continue to be responsible for any
transactions incurred on the analyzer(s).
2. User understands and agrees to be responsible for any access code or password associated
with the access into the Vehicle Information Database (VID). The user’s access codes and
passwords should not be shared and must be kept secure. Nevada DMV will not be liable for
any charges fraudulently incurred on the analyzer(s). The customer is responsible for all
transaction charges.
CERTIFICATE OF APPLIANT FOR PROGRAM PARTICIPATION
Please initial next to each statement as acknowledgement that you have read and agree to all
requirements of this program.
I have read this form and believe all the information is true and correct. By submitting
this signed form, I acknowledge and accept that the customer responsibilities are made
apart of this application and am in agreement with said terms.
I further acknowledge and accept the terms with control of the application including the
responsibility to pay all costs incurred from the analyzer(s), and from the CARRS
Application.
VERIFICATION
I, (we), the undersigned hereby certify that under penalty of perjury, that I (we) am/are the applicant
making the foregoing application, and that the application has been read and the contents thereof
and all statements contained herein are true, correct and complete to the best of my knowledge and
belief.
Signed
Date
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Compliance Enforcement Division Emission Control Program 555 Wright (Department of Motor Vehicles )

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Completed 24 December 2020

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