Fillable ROTATION TOW LISTING APPLICATION (California)

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ROTATION TOW LISTING APPLICATION (California)

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STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
ROTATION TOW LISTING APPLICATION
CHP 234A (Rev. 3-15) OPI 061
TYPE OR PRINT CLEARLY
RATES
CHP AREA
BUSINESS
HAVE YOU OR ANYONE FINANCIALLY INVOLVED WITH YOUR COMPANY EVER BEEN CONVICTED OF ANY CRIME INVOLVING STOLEN OR EMBEZZLED VEHICLES,
FRAUD RELATED TO THE TOWING BUSINESS, STOLEN OR EMBEZZLED PROPERTY, CRIMES OF VIOLENCE, SEXUAL CRIMES, DRUG RELATED OFFENSES, FELONY
DRIVING WHILE UNDER THE INFLUENCE OF ALCOHOL AND/OR DRUGS, MISDEMEANOR DRIVING WHILE UNDER THE INFLUENCE OF ALCOHOL AND/OR DRUGS WHILE
INVOLVED IN A CHP ROTATION TOW CALL, OR MORAL TURPITUDE?
VEHICLE STORAGE
FINANCIAL INTEREST
DO YOU HAVE ANY FINANCIAL INTEREST IN ANY OTHER TOW COMPANY WITHIN THE LOCAL
CHP AREA?
YES NO
ARE YOU CURRENTLY ON ROTATION OR APPLYING FOR ROTATION WITHIN ANY OTHER CHP
AREA?
YES NO
DO YOU SHARE ANY FACILITIES WITH ANY OTHER TOW COMPANY?
YES NO
Class A Class B Class C Class D
HOURLY RATE
INSIDE STORAGE
OUTSIDE STORAGE
LABOR (NONSKILLED)
SPECIAL EQUIPMENT (LIST)
RENTAL/SKILLED LABOR MARKUP (%)
YES NO
OWNED LEASED RENTED
OWNED LEASED RENTED
OWNED LEASED RENTED
DOES ANY MEMBER OF YOUR FAMILY (RELATED BY BLOOD OR MARRIAGE) OPERATE ANOTHER
TOW SERVICE IN THE LOCAL CHP AREA?
YES NO
CHP AREA OF APPLICATION CHP AREA NUMBER
BUSINESS NAME CHP AREA NAME
BUSINESS ADDRESS DAY PHONE NUMBER (INCLUDE AREA CODE)
BUSINESS MAILING ADDRESS IF DIFFERENT THAN ABOVE NIGHT PHONE NUMBER (INCLUDE AREA CODE)
NUMBER OF YEARS IN TOWING BUSINESS
AUTOMOBILE CLUB AFFILIATE(S)
PRIMARY STORAGE YARD ADDRESS
SECONDARY STORAGE YARD ADDRESS
ADDITIONAL STORAGE YARD ADDRESS
OUTSIDE STORAGE CAPACITY
INSIDE STORAGE CAPACITY
LEGAL OWNER (IF FIRM, COMPANY, ASSOCIATION OR CORPORATION, LIST ALL PERSONS HAVING FINANCIAL INTEREST)
IF YES, LIST THE TOW COMPANY(S):
IF YES, LIST THE OTHER TOW COMPANY(S):
IF YES, LIST THE OTHER CHP AREA(S):
IF YES, LIST THE OTHER CHP AREA(S):
Destroy Previous Editions
Chp234A_0419.pdf
TOW TRUCKS
CLASS A (MINIMUM 14,000 GVWR)
CLASS B (MINIMUM 33,000 GVWR)
CLASS C (MINIMUM 52,000 GVWR)
CLASS D (MINIMUM 54,000 GVWR)
CHP 234A (Rev. 3-15) OPI 061 PAGE 2
I CERTIFY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT, AND NO OMISSIONS HAVE BEEN MADE. THE OPERATOR IS ADVISED
THAT GIVING FALSE INFORMATION TO A PEACE OFFICER, EITHER ORALLY OR IN WRITING, IS A MISDEMEANOR PURSUANT TO CALIFORNIA VEHICLE CODE
SECTIONS 20 AND 31.
TO BE COMPLETED BY CHP
MAXIMUM RESPONSE TIME
HOURS CLASS A CLASS B CLASS C CLASS D
DAY
NIGHT
AGREEMENT TERM
THE TERM OF THIS AGREEMENT SHALL COMMENCE ON
AND END ON .
DIVISION APPROVAL (REQUIRED IF APPLYING FOR MULTIPLE AREAS)
APPROVED DISAPPROVED
REMARKS
AREA APPROVAL
APPROVED DISAPPROVED
SIGNATURE PRINT NAME AND TITLE DATE
REMARKS (REQUIRED IF DISAPPROVED)
AREA COMMANDER'S SIGNATURE I.D. NUMBER DATE
APPLICANT'S CERTIFICATION
CHECK CLASS(ES) APPLYING FOR AND INDICATE TOTAL NUMBER OF TRUCKS IN EACH CLASS.
NUMBER OF CLASS A TRUCKS:
NUMBER OF CLASS B TRUCKS:
NUMBER OF CLASS C TRUCKS:
NUMBER OF CLASS D TRUCKS:
COMMENTS
DIVISION COMMANDER'S SIGNATURE DATE
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Chp234A_0419.pdf
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ROTATION TOW LISTING APPLICATION (California)

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Completed 17 May 2021

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