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Michigan Intrastate Limousine Certificate of Authority

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					 Michigan Department            INTRASTATE CERTIFICATE OF AUTHORITY APPLICATION
   of Transportation
     3064 (04/12)                                         LIMOUSINE CARRIER

                                                      APPLICATION INFORMATION
1. BUSINESS/COMPANY NAME (Insurance and legal documents must match this name)
NAME                                                             DBA (if applicable)




2. BUSINESS MAILING
ADDRESS                                                         ADDRESS 2


CITY                                      COUNTY                     STATE/PROVIDENCE             ZIP/POSTAL CODE


PHONE NUMBER FOR PUBLIC TO CALL              FAX NUMBER                                PHONE NUMBER OTHER
(      )                                     (      )                                  (      )

WEB PAGE ADDRESS                                                 E-MAIL ADDRESS


3. INDICATE THE TYPE OF FACILITIES FOR YOUR BUSINESS (Choose all that apply)
         Office           Garage          Home           Other (Specify) _________________________________________________


4. REPRESENTATIVE INFORMATION TO WHOM INQUIRIES SHOULD BE DIRECTED:
NAME                                                             TITLE


ADDRESS (Address can not be a P.O. box)


CITY                                                                  STATE/PROVIDENCE            ZIP/POSTAL CODE


PHONE NUMBER                                                     CELL PHONE NUMBER
(      )                                                         (      )


5. FORM OF BUSINESS

   A.     SOLE PROPRIETORSHIP, WITH THE PERSON DOING BUSINESS AS: (Provide Certificate of Assumed Name, if applicable)


          PARTNERSHIP, WITH THE PERSONS DOING BUSINESS AS: (Provide Articles of Co-Partnership)


   B.     CORPORATION OR CORPORATION OPERATING UNDER THE ASSUMED NAME OF: (Corporations must provide Articles
          of Incorporation and, if not a Michigan corporation, a Certificate to Conduct Business in Michigan.)

                                      STATE OF INCORPORATION                               YEAR OF INCORPORATION


   C.     LIMITED LIABILITY COMPANY (LLC) OPERATING UNDER THE NAME OF: (Provide Articles of Organization)


   D.     OTHER:




                                                              Clear Form
MDOT 3064 (04/12)


6. OWNERS AND PRINCIPALS ARE:
NAME                                                                            TITLE                                              PHONE NUMBER


ADDRESS                                                                                     CITY                                     STATE      ZIP CODE


NAME                                                                            TITLE                                              PHONE NUMBER


ADDRESS                                                                                     CITY                                     STATE      ZIP CODE


NAME                                                                            TITLE                                              PHONE NUMBER


ADDRESS                                                                                     CITY                                     STATE       ZIP CODE


NAME                                                                            TITLE                                              PHONE NUMBER


ADDRESS                                                                                     CITY                                     STATE       ZIP CODE


NAME                                                                            TITLE                                              PHONE NUMBER


ADDRESS                                                                                     CITY                                     STATE        ZIP CODE




7. ENTER ADDRESSES FOR OFFICE OR GARAGE LOCATIONS NOT LISTED IN #2 ABOVE




8. TYPE OF CARRIER OPERATIONS (check all that apply)

          Intra-State (Only Within Michigan’s Borders)

          Intra-State and Inter-State (Within and Across Michigan’s Borders)

          Current Numbers Issued (if applicable): USDOT# _______________________________________ MC# _______________________

          Applied to FMCSA and awaiting number(s)

          Future Interstate Application Possible
9. CERTIFICATION

I, (print) __________________________________________________certify that all information supplied on this form or relating to this Application is
true and correct. If representing a company, corporation, or organization, I further certify that I am authorized to submit this information. I further certify
that the applicant is fit, willing, and able to provide the proposed operations and to comply with all pertinent statutory and regulatory requirements.
Furthermore, by signing this application, and as a condition to receiving a license (Certificate of Authority) to operate from the State of Michigan, all
limousine applicants who will operate a Class B Limousine (less than seven (7) passengers, including the driver) at any time within the City of Detroit
city limits for the purpose of picking up passengers, hereby agrees to comply with that cities vehicle for-hire ordinance pursuant to the requirements of
MCL 257.1907 being Section 7 of Public Act 271 of 1990, the Limousine Transportation Act.
SIGNATURE OF APPLICANT                                           TITLE                                                             DATE
  Michgian Department
   of Transportation
     3064 (04/12)                                                                      VEHICLE ROSTER
INSTRUCTIONS:

I.           REGISTER ALL revenue motor vehicles having a manufacturers rated seating capacity of fifteen (15) persons or less, including the driver.
II           COMPLETE safety inspection for each vehicle listed. Registration will not be processed if a safety inspection has not been completed within the previous
             twelve (12) months.
III.         SUBMIT PAYMENT for registration fee of $50.00 per vehicle.


               MODEL                                             VEHICLE                                                                                                                       SEATING
     FLEET                                                                        VEHICLE
               YEAR             MAKE            MODEL              TYPE                                    VEHICLE IDENTIFICATION NUMBER                                LICENSE               CAPACITY
      NO.                                                                          COLOR
                                                                (see code)                                                                                              PLATE NO.             (w/ driver)




CODES                                                                                                             COMPANY NAME                                                  DBA (If applicable)

1.           Car
                                                                                                                  COMPANY PERSON
2.           SUV
3.           Van
4.           Van Cutaway                                                                                          ADDRESS
5.           Limo-Bus
6.           School Bus Type
                                                                                                                  CITY                                                                STATE           ZIP CODE
7.           Motor Coach
8.           Other
                                                                                                                  TELEPHONE NO.


                                                                                                                  USDOT NO. (if applicable)
MDOT 3064 (04/12)
                     INSTRUCTIONS FOR RECEIVING LIMOUSINE AUTHORITY
                    FROM THE MICHIGAN DEPARTMENT OF TRANSPORTATION

            Public Act 271 of 1990 is the act which regulates the for-hire transportation of passenger
            by limousine. A limousine is described as any motor vehicle, regardless of body style,
            having a seating capacity of 1 to 15 passengers (including the driver). Any business
            entity that assesses a fee, monetary or otherwise, directly or indirectly, for the
            transportation of passengers is operating “for-hire”. Act 271 prohibits entities providing
            the services described from operating upon any public highway in Michigan without
            obtaining a Certificate of Authority from the Michigan Department of Transportation
            (MDOT). The processes of applying for, receiving, and maintaining a Certificate of
            Authority is described below.

            An application for limousine authority consists of the following elements:

                •   Intrastate Certificate of Authority Application (MDOT form 3064): This is a
                    three page document that requests information about the company and vehicles to
                    be registered (available on our website). To verify your authority to operate a
                    business in Michigan you must attach one of the following to the completed
                    application form:

                       ○ Copy of the Certified Articles of Incorporation, Limited Liability
                         Corporation or copy of the applicant’s Certificate to Conduct Business
                         under an Assumed Name, or Articles of Co-partnership (if applicable), OR

                       ○ Copy of the Certificate to Conduct Business in Michigan (if incorporated
                         in a state other than Michigan). If needed, please contact the Corporations
                         & Securities Bureau at (517) 241-6400.

                •   Limousine Inspection (MDOT form 3049E): Each vehicle on your roster must
                    pass an annual inspection by a State of Michigan certified mechanic at a repair
                    facility that is registered with the State of Michigan (Secretary of State).
                        o You must verify that the mechanic conducting the inspection meets the
                             following minimum requirement:
                                      Vehicles with GVWR of 10,000 lbs or less: AUTO Front End,
                                      Suspension & Steering Systems, and AUTO Brakes & Braking
                                      Systems.
                                      Vehicles with GVWR over 10,000 lbs: HDT Drive Train, HDT
                                      Brakes & Braking Systems, and HDT Suspension & Steering
                                      Systems.
                        o The mechanic performing the inspection must complete and sign a
                             Limousine Inspection form (available on our website) for each vehicle. If
                             a vehicle does not pass the inspection, it must be repaired and re-inspected
                             until it passes.
                        o Inspections must be conducted and new inspection forms submitted to
                             MDOT every 12 months. The registration decals will be issued when the
                             inspection form is received.
MDOT 3064 (04/12)   o Any vehicle not passing an inspection within 12 months of the prior
                        inspection will no longer be legal to operate as a for-hire vehicle in
                        Michigan. Per the terms of Act 271, a $500 fee must be paid before
                        MDOT can issue a new registration decal for the vehicle and it is
                        considered legal to operate.
            •   Proof of Insurance (MDOT form 3046): Your insurance company (not local
                agent) must submit MDOT form 3046 (Certificate of Insurance) directly to our
                office, certifying that you have the proper coverage for your fleet. Most insurance
                companies have this form on file. No other certificate of insurance will be
                accepted. Besides Michigan basic no-fault coverage, the following levels of
                coverage are required:
                    o For limousines with seating capacity of 1 to 9 passengers including the
                        driver – bodily injury and property damage liability with a minimum
                        combined single limit of $1,000,000.00 for all persons injured or for
                        property damage
                    o For limousines with seating capacity of 10 to 15 passengers including the
                        driver – bodily injury and property damage liability with a minimum
                        combined single limit of $2,000,000.00 for all persons injured or for
                        property damage
            •   Applicant Filing Fee: The following fees must be paid via check (mailed with
                your other documents) or via credit card (called into the Finance cashier at 517-
                373-1506):
                    o $300 application fee.
                    o $50 per vehicle; NOTE: this is an annual fee.

         All MDOT forms listed above, along with other information pertaining to limousine
         certificates of authority, can be found on our web site at www.michigan.gov/mdot. At the
         left of the screen select Rail and Public Transit, then select Bus & Limo Licensing from
         the center of the next page.

         Mail all completed application materials (form 3064 with a copy of legal document, form
         3049E for each vehicle listed on your roster, and your fee if paying by check) to:

                                      Michigan Department of Transportation
                                      P.O. Box 30648
                                      425 W. Ottawa St.
                                      Lansing, MI 48909

         The application will typically be reviewed within 2 weeks of receipt if received between
         March 1 and December 31. Applications received during the annual renewal period
         (January 1 through March 1) will be prioritized behind renewal applications and therefore
         the review may be delayed by several weeks. We are required by law to process
         applications within 90 days of receiving a properly completed application. If items are
         missing or incomplete, you will receive a letter stating what needs to be corrected; no
         further processing of the application will take place until all items have been correctly
         submitted. After all elements of the application have been received a Certificate of
MDOT 3064 (04/12)


            Authority will be issued to the carrier along with annual registration decals to be placed
            on each vehicle.

            We will send out a renewal packet in January for fees and updated information that is due
            by the last day of February. However, you are responsible for completing your annual
            inspections on time keeping in mind that your inspection dates may differ from your
            registration date (if you added vehicle mid-year, for example), and for keeping your
            insurance active at all times. Failure to complete any annual requirement will result in a
            fee or revocation of your authority.

            If you need assistance or have questions concerning the application process, you may call
            one of the numbers below:

                    Company names beginning with A-K call (517) 241-0679
                    Company names beginning with L-Z call (517) 241-0680

				
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