West Virginia Code of State Rules › Agency 150 - Public Service Commission › Title 150 - EXEMPT LEGISLATIVE RULE PUBLIC SERVICE COMMISSION › Series 150-09 - Rules Governing Motor Carriers, Private Commercial Carriers, and the Filing of Evidence of Insurance and Financial Responsibility by Motor Carriers › Section 150-9-10 - Forms

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. The following
				forms are adopted for use in the administration of motor carrier law. The
				Commission may accept papers in forms other than those prescribed if they
				contain the necessary information and arc legible.
10.1.1. P.S.C. W. Va. M.C. Form No. 4-N --
				Application for issuance of Uniform Vehicle Identification Cards and fees
				required by W. Va. Code §24A-6-6.
10.1.2. P.S.C. W Va. M.C. Form No. 4- N UCR
				-- Application for issuance of Uniform Vehicle Identification Cards for those
				entities not required to pay the fees set forth in W. Va. Code §24-6-6
				because of the Unified Carrier Registration Act of 2005.
10.1.3. P.S.C. W. VA. M.C. Form No. 5 -
				Application for permit to operate as a contract carrier by motor vehicle of
				passengers or property.
10.1.4.
				P.S.C. W. VA. M.C. Form No. 5-A -- Application for amendment of permit to
				operate as a contract carrier by motor vehicle of passengers or
				property.
10.1.5. P.S.C. W. VA.
				M.C. Form No. 5-B - Application by contract carrier by motor vehicle to adopt
				trade name.
10.1.6. P.S.C. W. VA.
				M.C. Form No. 5-C - Application by contract carrier by motor vehicle to change
				trade name.
10.1.7. P.S.C. W. VA.
				M.C. Form No. 6 - Application for a certificate of convenience and necessity to
				operate as a common carrier by motor vehicle of property.
10.1.8. P.S.C. W. VA. M.C. Form No. 6-A -
				Application for amendment of certificate of convenience and necessity to
				operate as a common carrier by motor vehicle.
10.1.9. P.S.C. W. VA. M.C. Form No. 6-B -
				Application by common carrier by motor vehicle to adopt trade name.
10.1.10. P.S.C. W. VA. M.C. Form No. 6-C --
				Application by common carrier by motor vehicle to change trade name.
10.1.11. P.S.C. W. VA. M.C. Form No. 8 -
				Application for a certificate of convenience and necessity to operate as a
				common carrier by motor vehicle of passengers.
10.1.12. P.S.C. W. VA. M.C. Form No. 8-A -
				Application for registration - charter bus service.
10.1.13. P.S.C. W. VA. M.C. Form No. 11 -
				Application for approval of the transfer and assignment of certificate(s) of
				convenience and necessity and/or permits [to be completed by the present holder
				of certificate(s) and/or permit(s)].
10.1.14. P.S.C. W. VA. M.C. Form No. 11-A -
				Application for approval of the transfer and assignment of certificate(s) of
				convenience and necessity and/or permits [to be completed by the proposed
				holder of certificate(s) and/or permit(s)].
10.1.15. P.S.C. W. VA. M.C. Form No. 17 --
				Notice of cancellation of motor carrier policies of insurance [for use under
				insurance rules].
10.1.16. P.S.C.
				W. VA. M.C. Form No. 18 - Notice of cancellation of motor carrier surety bonds
				[for use under insurance rules].
10.1.17. P.S.C. W. VA. M.C. Form No. 21 -
				Application for authority to self-insure [for use under insurance
				rules].
10.1.18. P.S.C. W. VA. M.C.
				Form No. 22-A -- Endorsement for motor carrier policies of insurance for bodily
				injury liability and property damage liability [for use under insurance
				rules].
10.1.19. P.S.C. W. VA. M.C.
				Form No. 23 -- Endorsement for motor common carrier policies of insurance for
				cargo liability [for use under insurance regulations].
10.1.20. P.S.C. W. VA. M.C. Form No. 24-A -
				Certificate of insurance for motor carrier policies of insurance for bodily
				injury and property damage liability [for use under insurance
				regulations].
10.1.21. P.S.C. W.
				VA. M.C. Form No. 25 -- Certificate of insurance for motor carrier policies of
				insurance for cargo liability [for use under insurance rules].
10.1.22. P.S.C. W.VA.M.C. Form No. 31 -
				Certificate of lease.
10.1.23.
				P.S.C. W. VA. M.C. Form No. 33 -- Affidavit of contractor in support of
				application for permit.
10.1.24.
				P.S.C. W. VA. M.C. Form No. 35 - Tariffs of rates, rules, and regulations by
				common carriers by motor vehicle of passengers or property and by contract
				carriers by motor vehicle of passengers or property.
10.1.25. P.S.C. W. VA.M.C. Form No. 44 - Out
				of Service Vehicle Sticker.
10.1.26. P.S.C. W. VA. M.C. Form No. 45-A -
				Motor Carrier bodily injury liability and property damage liability surety bond
				[for use under insurance rules].
10.1.27. P.S.C. W. VA. M.C. Form No. 46 -
				Motor common carrier cargo liability surety bond [for use under insurance
				rules].
10.1.28. P.S.C. W.VA.M.C.
				Form No. 49 - Violation notice.
10.1.29. P.S.C. W. VA. M.C. Form No. 52 -
				Taximeter Inspection Report.
10.1.30. P.S.C. W. VA. M.C. Form No. 55 --
				Taxicab Driver's Lease Agreement and Daily Manifest.
10.1.31. P.S.C. W. VA. M.C. Form No. 56 --
				Citation and Complaint.
10.1.32.
				P.S.C. W. VA. M.C. Form No. 57 -- Incident Report -- Hazardous
				Material.
10.1.33. P.S.C. W.VA.M.C.
				Form No. 58 - Driver/Vehicle Report.
10.1.34. P.S.C. W. VA. M.C. Form No. 59 -
				Carrier Safety/Compliance Review Form.
10.1.35. P.S.C. W. VA. M.C. Form No. 60 -
				Vehicle Registration Approval Form.
10.1.36. P.S.C. W.VA.M.C. Form No. 62 -
				Accident Report.
10.1.37. P.S.C. W.
				VA. M.C. Form No. 63 -- Motor Carrier Insurance Registration Form.
10.1.38. P.S.C. W. VA. M.C. Form No. 64 -
				Letter of Insurance Registration.
10.1.39. P.S.C. W. VA. M.C. Form No. 65 --
				Third-Party Tow Form of Invoice.
FORMS MAY BE OBTAINED FROM THE SECRETARY OF STATE'S
				  OFFICE.
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