Fillable Form CHP 362 MOTOR CARRIER PROFILE california

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Form CHP 362 MOTOR CARRIER PROFILE california

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Safety, Service, and Security An Internationally Accredited Agency
Page 1 of 5
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Chp362_0419.pdf
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
MOTOR CARRIER PROFILE
CHP 362 (Rev. 3-18) OPI 062
Available at www.chp.ca.gov
If your company already has a CA number issued by the CHP and this Motor Carrier
Profile is submitted to update your organization's information, check the "Update" box
and enter your CA number below:
CA-
New Update
EIN SSN
PART 1. LEGAL NAME Complete for Individual, Partnership, Corporation or Limited Liability Company (one only)
Letter
◄
Numbers only
►
Corporation, Partnership, or Certificate of Qualifications No. issued by California Secretary of State:
First Name Middle Initial
Last Name
Required ►
Driver License No. Driver License State
EIN
(Indicate "Doing Business As" names in Part 5)
Individual (Sole Proprietorship)
Partnership
Corporation (Public agencies and non-profit organizations, check this box whether incorporated or not)
Limited Liability Company (LLC) (Registered with the California Secretary of State)
If no EIN, enter SSN.
State or Local Government Agency
Non-Profit Organization (Check only if qualified for tax exemption under Section 501(c) of the Internal Revenue Code.)
Legal Name of Company or Organization (See also Part 5, Doing Business As)
Limited Liability Company Entity Number assigned by the California Secretary of State:
◄ ►
Numbers only
Executive Officer:
First Name
Middle Initial
Last Name
PART 2. PRINCIPAL PLACE OF BUSINESS
Physical Address:
Mailing Address
(if different):
Street Address City State Zip Code
Street Address or P.O. Box City State Zip Code
Fleet Mileage in California (Total fleet intrastate and interstate miles in California for most recent full calendar year.)
for calendar year
(miles) (year)
Business E-mail Address:
Business Telephone Number: Business Fax Number:
CHP USE ONLY
County Code CHP Location Code
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).
Safety, Service, and Security An Internationally Accredited Agency
Page 2 of 5
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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.
Name Day Telephone with Area Code Night Telephone with Area Code
Name Day Telephone with Area Code Night Telephone with Area Code
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.
A. Truck
B. Hazardous Materials
Carrier
C. Hazardous Materials
Shipper
D. Hazardous Waste
Transporter
E. Flammable Liquid Cargo Tank
F. Bus w/o Operating Authority
(public transit or private)
G. Tour Bus (CPUC or FMCSA
authority)
H. School Bus
I. School Pupil Activity Bus
J. Youth Bus
K. General Public Paratransit
Vehicle
L. Farm Labor Vehicle
M. Vehicle or combination
described in VC 34500 (k)
N. Vehicle described in
VC 34500(j)
O. Modified Limousine
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
US DOT (Required) MC MX IRP IRP Base State
Cal-T (Household Goods) PSG (For-hire passenger only) PSC TCP
PART 7. CALIFORNIA TERMINALS (Attach additional pages if necessary; provide the same information for each terminal)
California Terminal DBA and Address
(DBA must match Part 5)
City Name
Zip
Code
Phone
Number
Driver
Records?
Vehicle
Records?
CHP
USE
ONLY
NY
Y N
Doing Business As
Address
Area
Subarea
NY
Y N
Doing Business As
Address
Area
Subarea
NY
Y N
Doing Business As
Address
Area
Subarea
NY
Y N
Doing Business As
Address
Area
Subarea
If the CHP needs to clarify any of the information your organization has provided, who should be contacted by telephone for assistance?
Name (Type or print) Day Telephone
Date this Carrier Profile was prepared (information current as of):
Safety, Service, and Security An Internationally Accredited Agency
Page 3 of 5
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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".
Northern Division .................
2485 Sonoma Street
Redding, CA 96001-3026
(530) 242-4357
(530) 246-1264 Fax
Valley Division ......................
2555 First Avenue
Sacramento, CA 95818-2608
(916) 731-6350
(916) 227-0111 Fax
Golden Gate Division ............
1551 Benicia Road
Vallejo, CA 94591-7568
(707) 917-4300
(707) 649-4766 Fax
Central Division ....................
5435 East Olive Avenue
Fresno, CA 93727-2541
(559) 453-3130
(559) 452-1251 Fax
Southern Division ........................
437 North Vermont Avenue
Los Angeles, CA 90004-3512
(323) 644-9557
(323) 953-4827 Fax
Border Division ............................
9330 Farnham Street
San Diego, CA 92123-1216
(858) 650-3655
(858) 637-7159 Fax
Coastal Division ...........................
4115 Broad Street Suite B-10
San Luis Obispo, CA 93401-7992
(805) 549-3261
(805) 541-2871 Fax
Inland Division ..............................
847 East Brier Drive
San Bernardino, CA 92408-2837
(909) 806-2414
(909) 885-0981 Fax
CONTACT THE FOLLOWING OFFICES BY SPECIAL INSTRUCTION ONLY.
UNAUTHORIZED USE WILL DELAY PROCESSING OF YOUR APPLICATION.
Commercial Records Unit.....
P.O. Box 942898
Sacramento, CA 94298-0001
(916) 843-4150
(916) 843-3898 Fax
Commercial Vehicle Section.......
P.O. Box 942898
Sacramento, CA 94298-0001
(916) 843-3400
(916) 322-3154 Fax
Safety, Service, and Security An Internationally Accredited Agency
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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.
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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.
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Completed 20 December 2019

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