Attachment 6: DLA Form 2503 Transporter App

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TRANSPORTER QUALIFICATION REVIEW APPLICATION

Prescribed by: DRMS I 4160.14
Sponsor: Disposition Services

Instructions: Please complete form electronically and save file using name of carrier.

1. Transporter Name:

2. Transporter 12 Digit I.D. Number (if applicable):

Instructions: Complete all sections and provide backup documentation 3. Transporter Address: where requested. If the requested information is not applicable, please identify as N/A.

4. List primary waste transporter

permit numbers:

Motor Carrier Safety (CONUS Only)
5. Federal Motor Carrier Safety Administration (FMCSA) USDOT Number:

7. List dates, city and state location of any Federal or State safety violations in the last 3 years:

6. FMCSA audit date:

8. Has the company had any traffic citations or hazardous materials incidents within the last three years?
Yes

No

If yes, provide enforcement agency copies of traffic citations or hazardous materials incident report.
9. Provide current Office of Motor Carrier Safety (OMCS) or State DOT rating:

Risk Mitigation

10. Does company have a

written hazardous materials
safety training program?

Yes

No

If yes, provide a copy of the
training program.

11. Does company maintain general,
property, bodily injury and pollution
liability insurance coverage?

12. Are all loads transported by company owned/leased vehicles?

Yes

Yes

No

If yes, provide copy of
insurance certificates.

No

If no, all contractors must meet same criteria to qualify as a DLA approved transporter. Yes

13. Will carrier be providing transportation services using marine vessels?

No

If question 13 was yes, carrier is required to submit International Maritime Dangerous Goods (IMDG) transportation licenses. 14. Will CONUS carrier be required to transport material outside the continental United States or is this an overseas transporter? If yes to question 14, provide list of countries below and submit foreign country license documentation.

Yes

No

Company Representation

15. Name of representative completing application:

Date:

16. Phone number and e-mail of primary contact
person for transporter:

For DLA Use Only
As the verifier, I certify that the information provided on this form is true and correct.

NAME OF DLA VERIFIER:

DLA FORM 2503, SEP 2016

VERIFIER SIGNATURE & DATE:

PDF (DLA)