Drug and Alcohol Testing Passenger Motor Carrier Affidavit of Applicability

Owner or Owner Representative: Review the following and fill out the form below.

Per Section 507-A of the NY State Vehicle and Traffic Law, Passenger Motor Carriers must conduct pre-employment and random drug / alcohol testing if the following apply:

The motor carrier offers for-hire services, and
operates one or more vehicles with a seating capacity of 9 or more passengers (including the driver).

For the purposes of Section 507-A of the NY State Vehicle and Traffic Law, the term 'for-hire' shall mean a taxicab or livery having a seating capacity of nine or more passengers, including the driver, including an altered motor vehicle commonly referred to as a "stretch limousine" having a seating capacity of nine or more passengers, including the driver.

Required fields are marked with an asterisk (*).

REGISTRANT INFORMATION

Complete the following registrant information:

Please note: Your unique identifier is found below your address on the Affidavit of Compliance letter you received from DMV.

Unique identifier: *

Name as it appears on the registration: *

Company name (if applicable):

Address 1: *

Address 2:

City: *

State: *

ZIP code: *

Phone number: *

Plate number of one of the vehicles operated under this registrant name: *

STATEMENT OF SERVICES

Select the option that applies: *

I am the/an owner, or otherwise represent the owner(s), of motor carrier(s) that employ drivers of vehicles that seat nine or more passengers including the driver. I understand that as per the New York Vehicle and Traffic Law and New York State DMV Commissioner’s Regulations, I am responsible for conducting pre-employment and random drug testing of drivers in my employ. By checking this box, I agree, either on my own behalf or the behalf of the company I represent, to comply with completing pre-employment and random drug testing of drivers as required by New York State Law.

The company/individual on this form does NOT offer for-hire services, OR does not have vehicles within its fleet that seat nine or more passengers including the driver.

ACKNOWLEDGEMENT & CERTIFICATION

I agree, and it is my intent, to sign this document by entering my name and title below and by electronically submitting this document to the New York State Department of Motor Vehicles. I understand that by electronically signing and submitting this document in this fashion, it is the legal equivalent of having placed my handwritten signature on the submitted document and this affirmation. I also understand and agree that by electronically signing and submitting this document in this fashion, I am affirming to the truth of the information contained therein.

I affirm the information I have provided on this form is true and complete. I understand that making any false statement on this form, or submitting any documentation in support of this form that is false, may be punishable as a criminal offense.

Certify by checking 'I AGREE' and provide information for the individual completing this form: *

I AGREE

Name of owner / owner representative (first, last): *

Title of owner / owner representative: *

Email: *

Department of Motor Vehicles