Form FDACS-10960 "Household Moving Services Registration Application" - Florida

Form FDACS-10960 is a Florida Department of Agriculture and Consumer Services form also known as the "Household Moving Services Registration Application". The latest edition of the form was released in October 1, 2016 and is available for digital filing.

Download an up-to-date fillable Form FDACS-10960 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-10960 "Household Moving Services Registration Application" - Florida

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FLORIDA DEPARTMENT OF AGRICULTURE
AND CONSUMER SERVICES
ADAM H. PUTNAM
COMMISSIONER
HOUSEHOLD MOVING SERVICES
REGISTRATION APPLICATION
Chapter 507, Florida Statutes
Rule 5J-15.001, Florida Administrative Code
FLORIDA DEPARTMENT OF AGRICULTURE
AND CONSUMER SERVICES
ADAM H. PUTNAM
COMMISSIONER
HOUSEHOLD MOVING SERVICES
REGISTRATION APPLICATION
Chapter 507, Florida Statutes
Rule 5J-15.001, Florida Administrative Code
Florida Department of Agriculture and Consumer Services
Household Moving Services Registration Application
Table of Contents
Filing Instructions
Page II
Application Checklist
Page II
Pages 1 – 4
Registration Application
If you have any questions, please contact the department at 1-800-HELP-FLA (435-7352), (850) 410-3800, or via fax at
(850) 410-3804.
FDACS-10960 Rev. 10/16
Page I of IV
Instructions and Checklist for Completing the Registration Application
No person may engage in the intrastate moving of household goods, moving of goods from one location in Florida to
another location in Florida (‘mover’), or arrange or refer a shipper to a mover for compensation (‘broker’) without first
complying with the requirements of Chapter 507, F.S. and obtaining approval from the Florida Department of Agriculture
and Consumer Services (FDACS) of the registration application. Registration fee is $600.00 for 2 years and is non-
refundable. Renewal applications will be mailed 45 days before the expiration of this registration and the renewal
application must be received on a form provided by the department prior to the expiration date. A person may not act as a
mover or broker after the expiration, suspension, or cancellation of the registration.
THIS FORM IS FOR NEW
REGISTRATIONS ONLY; IF YOU HAVE PREVIOUSLY REGISTERED WITH THE DEPARTMENT YOU MUST USE
THE RENEWAL FORM THAT WAS MAILED TO YOU BY THE DEPARTMENT.
MILITARY FEE WAIVER FOR INITIAL REGISTRATION
The department shall waive the initial registration fee for an honorably discharged veteran of the United States Armed
Forces, the spouse of such a veteran, or a business entity that has a majority ownership held by such a veteran or spouse if
the department receives FDACS-10960, Household Moving Services Registration Application, Rev. 10/16, FDACS-10991,
Military Veteran Fee Waiver Request, 10/16, and required documentation within 60 months after the date of the veteran’s
discharge from any branch of the United States Armed Forces. FDACS-10991, Military Veteran Fee Waiver Request, 10/16,
is incorporated by reference in rule 5J-26.001, F.A.C. Please see s. 507.03(3)(b), F.S., for waiver qualifications.
APPLICATION CHECKLIST AND INSTRUCTIONS
 Item # 1
If the applicant is not an individual, provide the legal name of the organization exactly as it appears in its articles of
incorporation or organizational document. If using a fictitious or trade name (DBA) provide that name also; you must list all
names by which you intend to operate as well as the date the fictitious name was filed with the Florida Department of State,
Division of Corporations.
Note: Corporate, LLC, Partnership, and Fictitious Names are verified with the
[s. 507.03, F.S.]
Florida Department of State, Division of Corporations and must match the name exactly as filed.
 Item # 2
Provide the physical street address for the applicant. Include the suite, room, or other unit number. If the mailing address
(e.g. a post office box) is different from the applicant’s street address, provide that address as well.
[s. 507.03, F.S.]
 Item # 3
You must provide a primary telephone number, including the area code, for the business.
[s. 507.03, F.S.]
 Item # 4
Provide the applicant’s federal employer identification number.
[s. 119.092, F.S.]
 Item # 5
Select the type of organization (or legal form of business), the charter (document) number, and when and where the
organization was legally established; and, if a foreign corporation, the date it registered with the Florida Department of
State, Division of Corporations.
[s. 507.03, F.S.]
 Item # 6
List representatives as directed with complete addresses for each.
[s. 507.03, F.S.]
 Item # 7
Provide the name, address, and telephone number of any other business locations to be included in this registration; only
those listed will be authorized to operate in Florida; all business locations in Florida must be provided.
[s. 507.03, F.S.]
 Item # 8
Provide name of all other corporations, business entities, and trade names through which each owner of the mover or
broker operated, was known, or did business as a mover or broker within the last 5 years.
[s. 507.03, F.S.]
 Items # 9-12
Answer by checking appropriate box and provide supplementary information, if applicable.
All crimes must be
disclosed regardless of the nature of the crime.
FDACS-10960 Rev. 10/16
Page II of IV
OTHER REQUIRED DOCUMENTS AND FEES
MOVERS
Certificate of insurance. Coverage must include:
___ Liability for loss or damage to household goods – not less than $10,000 per shipment
Or if you have two or fewer vehicles you may obtain:
___ Surety Bond
in the amount of $25,000 or an original Certificate of Deposit in the amount of $25,000.
(Original)
AND
___ Motor vehicle coverage, including bodily injury and property damage liability in minimum amounts of:
i. $50,000 per occurrence for a commercial vehicle with a gross weight of less than 35,000 pounds.
ii. $100,000 per occurrence for a commercial vehicle with a gross weight of more than 35,000 pounds
but less than 44,000 pounds.
iii. $300,000 per occurrence for a commercial vehicle with a gross weight of 44,000 pounds or more.
Insurance and surety must be issued by a company authorized to transact business in this state, the department
shall be named as a certificate holder and must be notified at least 10 days before any changes in insurance
coverage. Insurance coverage must be current and maintained throughout the registration period.
BROKERS
___ Surety Bond
in the amount of $25,000 or an original Certificate of Deposit in the amount of $25,000.
(Original)
Insurance and surety must be issued by a company authorized to transact business in this state, the department
shall be named as a certificate holder and must be notified at least 10 days before any changes in insurance
coverage. Insurance coverage must be current and maintained throughout the registration period. A sample
surety bond can be accessed online at www.800helpfla.com.
Send the completed application and a check or money order made payable to FDACS (all fees are non-
refundable):
FDACS
Household Moving Services
P.O. Box 6700
Tallahassee, FL 32314-6700
CONTRACTS AND ESTIMATES
[s. 507.05, F.S.]
Prior to providing any moving or accessorial services, a contract and estimate must be provided to a prospective shipper
in writing, must be signed and dated by the shipper and the mover, and must include:
1. The name, telephone number, and physical address where the mover's employees are available during normal
business hours.
2. The date the contract or estimate is prepared and any proposed date of the move.
3. The name and address of the shipper, the addresses where the items are to be picked up and delivered, and a
telephone number where the shipper may be reached.
4. The name, telephone number, and physical address of any location where the goods will be held pending further
transportation, including situations where the mover retains possession of goods pending resolution of a fee
dispute with the shipper.
5. An itemized breakdown and description and total of all costs and services for loading, transportation or shipment,
unloading, and accessorial services to be provided during a household move or storage of household goods.
6. Acceptable forms of payment. A mover shall accept a minimum of two of the three following forms of payment:
Cash, cashier's check, money order, or traveler's check;
(a)
Valid personal check, showing upon its face the name and address of the shipper or authorized representative; or
(b)
Valid credit card, which shall include, but not be limited to, Visa or MasterCard.
(c)
NOTE: A mover must clearly and conspicuously disclose to the shipper in the estimate and contract for services the forms
of payments the mover will accept, including the forms of payment described in paragraphs (a)-(c).
FDACS-10960 Rev. 10/16
Page III of IV
ADDITIONAL INFORMATION
A certificate evidencing proof of registration shall be issued by the department and must be prominently displayed in
the mover or moving broker's primary place of business.
Each contract of a mover or moving broker must include the phrase " (NAME OF FIRM) is registered with the state of
Florida as a Mover or Moving Broker. Registration No. _____."
Each advertisement of a mover or moving broker must include the phrase "Fla. Mover Reg. No. _____" or “Fla. IM
No.____”. Each of the mover’s vehicles must display a sign on the driver’s side door which includes at least one of
these phrases in lettering of at least 1.5 inches in height.
Storage of goods must adhere to provisions of s. 507.06, F.S.
Violations of the chapter as well as penalties for any violations are detailed in ss. 507.07-507.11, F.S.
CHANGES TO INFORMATION FILED
Registration is only valid for those locations designated in your application. Change of location or additional locations
must be submitted in writing in advance of any changes.
Registrations issued pursuant to this chapter are
[s. 507.03, F.S.]
not assignable or transferable.
Send changes to registration statement or proof of continuing insurance to:
FDACS
Household Moving Services
2005 Apalachee Parkway
Tallahassee, FL 32399-6500
FDACS-10960 Rev. 10/16
Page IV of IV
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