MAILTO:POBOX2007,Frankfort,KY40602-2007

Phone:(502)564-1257Fax:(502)564-4138

Drive.Ky.Gov

Applicationfor

NewAuthority orAuthorityforAdditionalVehicles

ThisformcontainsdocumentsrequiredforapplicationsforintrastateregularrouteBusmotorcarrierauthorityandforapplicationsforadditionalqualifiedvehiclesunderanexistingauthority.Thefollowingsectionsarecontainedinthisapplicationform:

ApplicationIndex

To Apply forBusAuthority

Youare required tofollowthese instructionstocomplete andmailor deliverthisapplication formincludingtheAuthorityApplication(Section2)andenclosetherequiredfeestotheTransportationCabinet,DepartmentofVehicleRegulation,DivisionofMotorCarriers,QualificationsandPermitsBranch,at200MeroStreet,Frankfort,KY 40622.Yourapplicationmaybereturnedfor the correctionofanydeficiencies.

Enclose a CheckorMoney Order

Youmustencloseonecheckormoneyordermadepayabletothe“KentuckyStateTreasurer”intheamountofthe$250applicationfeeplustheperqualifiedvehiclefeeof$100proratedforthemonththevehicleisfirstauthorizedforservice(SeechartinSection5,page8).($250applicationfee)+(numberofvehicles Xpervehicle feeof$100prorated forthemonthofservice$ )=totalfees$ .

Register yourBusinessorBusinessName

BusinessOrganizationsMustRegisterwiththeKentuckySecretaryofState

IfyouareabusinessorganizationthatisrequiredtoberegisteredwiththeKentuckySecretaryofStateinordertodobusinessinKentucky,youshallcompleteyourregistrationasadomesticorforeignbusiness organizationpriortosubmittingthisapplication. Ifyou haveany questionsregardingtheregistrationprocesspleasecontactyourattorneyortheofficeoftheKentuckySecretaryofState.

SoleProprietorsMustFileaCertificateofAssumedNamewiththeCountyClerk

IfyouareoperatingyourbusinessasasoleproprietoryouarenotrequiredtoandmaynotregisteryourbusinessnamedirectlywiththeKentuckySecretaryofState,butyouarerequiredtofileacertificateofassumednamewith thecountyclerkwhereyoumaintainyourprincipalplaceofbusiness.CompleteandrecordtheenclosedCertificateofAssumedNameforSoleProprietor(Section

3)thenenclosetherecordedcopywiththisapplication.

Commercial Insurance

YouarerequiredtohaveaninsurancecarrierauthorizedtotransactbusinessinKentuckyfileaFormE,UniformMotorCarrierBodilyInjuryandPropertyDamageLiabilityCertificateofInsurancedirectlywiththeDivisionofMotorCarrierspriortosubmittingthisapplication.TheFormEmustbeanoriginalandmayonlybefiledbyyourinsurancecarrierbymaildirectlytotheDivisionofMotorCarriersorthroughtheMotorCarrierInformationExchange(NOR)website.Faxedcopiesshallnotbeaccepted.Ifyouhavequestionsregardinghowtosubmittheformpleasecontactyourinsurancecompany.

Theminimumamountofliabilityinsuranceforapassengervehiclewith7regularseatsorlessshallbeonehundredthousanddollars($100,000)fordeathandpersonalinjurytoone(1)person,threehundredthousanddollars($300,000)fordeathandpersonalinjuryresultingfromone(1)incident,andfiftythousanddollars($50,000)forpropertydamage.Theminimumamountofliabilityinsuranceforapassengervehiclewith8regularseatsormoreshallbeonehundredthousanddollars($100,000)fordeathandpersonalinjurytoone(1)person,sixhundredthousanddollars($600,000)fordeathandpersonalinjuryresultingfromone

(1)incident,andfiftythousanddollars($50,000)forpropertydamage.

Qualification ofVehicles

YouarerequiredtoinitiallyqualifyatleastoneBusvehiclewiththeDivisionofMotorCarriersinconnectionwiththisapplication.Vehicles10,001lbs.orgreaterortransportmorethan8passengers(includingthedriver)forcompensation,requireaUSDOTnumber.OfficialplatedvehiclesareexemptfromtheUSDOTnumberrequirement.Youmayvisit vehicle to be operatedpursuant toagrant of authoritybeforeitmaybe lawfullyoperatedunderthatauthority.YoumustcompleteandsubmittheenclosedVehicleQualificationform(Section5)listingrequiredinformationforeachvehicletobequalified.Youmaymakeadditionalcopiesoftheblankformonpage9and submitasmanycompleted qualification formsasmaybenecessaryto list eachvehicleyou intendtoqualify.Youmayqualifyadditionalvehiclesunderanexistingauthorityatanytimebycompletingandresubmittingthisapplicationformforanamendmenttoanexistingauthority.Seepage4foradditionalqualification informationofadditional vehiclesunder an existingauthority.

RouteDescription

Youarerequiredtosubmitadetailedroutedescription,incompliancetoKRS281.010(43),ofthescheduledtransportationofpassengersbetweendesignatedpointsoverdesignatedroutesundertimeschedulesthatprovidearegularityofservices.

InspectionofVehicles

YoumusthaveanautomotiveservicetechniciancertifiedbytheNationalInstituteforAutomotiveServiceExcellence(ASE)toannuallyinspecteachvehicletobequalifiedandcompletetheenclosedVehicleInspectionform(Section4)annuallyforeachvehicle.Donotincludeacopyofacompletedvehicleinspectionformwiththisapplicationorotherwisesubmitavehicleinspectionformtothedepartment.Youarerequiredtomaintaineachvehicleinspectionforminyourrecordsforthreeyearsfromthedateofinspection.

Criminal BackgroundChecks

Youarerequiredtoobtainanationwidecriminalbackgroundcheck,incompliancewithKRS281.6301,ofeachowner,official,employee,independentcontractor,oragentoperatingapassengervehicle.Thebackgroundcheckshallbeobtainedandretainedforaperiodofatleastthreeyears.

Applyingto Qualify AdditionalVehicles underanExistingAuthority

Youmayusethisapplicationformtoapplytoqualifyadditionalvehiclesasanamendmenttoanexistingauthority.IfusingthisapplicationtorequesttheauthoritytoqualifyadditionalvehiclesanddriversyoushallsubmitonlytheAuthorityApplication(Section2),theVehicleQualificationform(Section5),listinginformationforeachadditionalvehicle,andencloseacheckormoneyordermadepayabletothe“KentuckyStateTreasurer”inanamountequaltotheprorated$100perqualifiedvehiclefee(SeechartinSection5,page8).The $250applicationfeeisnotrequiredto applyforadditional vehicles.

AuthorityandQualifiedVehicleCredentials

Foryoursecurity,iftheDepartmentofVehicleRegulationapprovesyourapplicationfornewauthorityorforadditionalqualifiedvehicles,theauthorityandvehiclecredentialsissuedbythedepartmentwillbemailedbyfirstclassmailtoyourmailingaddressonfilewiththedepartment.Alternatively,thecredentialsmaybedeliveredinpersontoeitheraSoleProprietororanauthorizedofficerofregisteredagentoftheCorporation,Partnership,orLimitedLiabilityCompanylistedwiththeKentuckySecretaryofStatewhoseidentitycanbeverified.Youmayrequestovernightorotherexpeditedmaildeliverybysubmittingwiththisapplicationacorresponding prepaidenvelopeaddressedtoyourmailingaddressonfile.

ApplicationProcessAssistance

If youhave questionsaboutthisapplicationform ortheapplication process,pleasecontact theDepartment ofVehicleRegulation,DivisionofMotorCarriers,QualificationsandPermitsBranch,byphoneat(502)564-1257orbyemail .

DocketNo.CompanyNo.CertificateNo.

(Requiredbyapplicantforadditionalvehicles)

USDOT Number Legalname Doingbusiness as Mailingstreet address City County State ZIP Phone Fax

Emailaddress(required)

SignatureDatePrintname Printtitle

(Departmentuse)

PursuanttotheprovisionsofKRS365.015,theundersignedappliestoassumeanameand,forthatpurpose,submitsthe followingstatement:

1. The assumedname is:
2. The legalnameoftheindividualadoptingthe assumedname is:
3. The street address is:
CityCounty / StateZIP

4. The mailingaddress is:
CityCounty / StateZIP

IdeclareunderpenaltyofperjuryunderthelawsofKentuckythattheforegoingistrueandcorrect.
Signature
Printname / Date
THISSIGNATURESHALLBENOTARIZED.
STATEOF
COUNTYOF
Subscribedandsworntobeforemeonthis / theday of / 20 .
NotaryPublic
Mycommissionexpireson / .

Anassumednameshallbeeffectiveforatermof five (5)years fromthe dateoffilingandmay berenewed forsuccessivetermsuponfilingarenewalcertificatewithinsix(6)monthspriortotheexpirationoftheterm,inthesamemanneroffilingtheoriginalcertificateof assumedname.

Date of Inspection / Odometer / Model Year / Make
Vehicle Type: / Sedan / Limousine / Minivan / Van / Other / Model
License Plate No. / VIN / Authority No.

(Departmentuse)

InspectionAddress / PrintNameofServiceTechnician
Company / ASECertificateNo.
Street / Phone
City / Email
State / ZIP / Signature
ProratedVehicleFeeChart / Qualificationyear / 20
Theannualqualificationfeefor aBusvehicle is
$100.00. For avehiclequalifiedafter January,the initial vehiclefeeisproratedaccordingtothisProratedVehicleFeeChart. / January / $100.00
February / $91.67 / Proratedpervehiclefee
March / $83.33
April / $75.00 / Numberofvehicles
May / $66.67
June / $58.33 / Totalvehiclefees
July / $50.00
August / $41.67 / (Completed byapplicant)
September / $33.33 / CertificateNo.
October / $25.00
November / $16.67 / VehicleQualificationFees / 39-$
December / $8.33

(Departmentuse)

(Departmentuse)

(Departmentuse)