Form ITD3051 "Usdot Safety Responsibility Statement" - Idaho

Form ITD3051 is a Idaho Department of Transportation form also known as the "Usdot Safety Responsibility Statement". The latest edition of the form was released in April 1, 2013 and is available for digital filing.

Download a PDF version of the Form ITD3051 down below or find it on Idaho Department of Transportation Forms website.

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Download Form ITD3051 "Usdot Safety Responsibility Statement" - Idaho

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USDOT Safety Responsibility Statement
Idaho Transportation Department – Motor Carrier Services
International Registration Plan (IRP) Vehicle Registration Information
Registration Year
Account Number
Fleet Number
IRP Account Name
Unit Number
Vehicle Year
Vehicle Make
Complete Vehicle Identification Number (VIN)
The above identified vehicle will operate under the safety responsibility of the following motor carrier
USDOT
Taxpayer ID Number (TIN) Motor Carrier Name
Contact Name
Contact Telephone Number
Contact Fax Number or E-mail Address
By signing below, the Safety Responsible motor carrier identified above agrees to:
Immediately advise the Idaho Transportation Department, Motor Carrier Services office if this
agreement is terminated. Notification must be in writing, submitted by fax to (208) 334-2006 or by
e-mail to cvs@itd.idaho.gov.
Maintain an active USDOT status classified as an Interstate Motor Carrier and comply with all
USDOT requirements, including timely updates and Unified Carrier Registration (UCR) filings.
Safety Responsible Motor Carrier Authorized Representative's Printed Name Title
Authorized Representative's Signature*
Date
*Cannot be signed by a licensing agent or third-party
Submit the completed and signed statement to:
Mail: Idaho Transportation Department
Motor Carrier Services
For office use only
PO Box 7129
Boise ID 83707-1129
Reviewed By:
Fax: (208) 334-2006
Date:
or
E-mail:
cvs@itd.idaho.gov
ITD 3051 (Rev. 04-13)
USDOT Safety Responsibility Statement
Idaho Transportation Department – Motor Carrier Services
International Registration Plan (IRP) Vehicle Registration Information
Registration Year
Account Number
Fleet Number
IRP Account Name
Unit Number
Vehicle Year
Vehicle Make
Complete Vehicle Identification Number (VIN)
The above identified vehicle will operate under the safety responsibility of the following motor carrier
USDOT
Taxpayer ID Number (TIN) Motor Carrier Name
Contact Name
Contact Telephone Number
Contact Fax Number or E-mail Address
By signing below, the Safety Responsible motor carrier identified above agrees to:
Immediately advise the Idaho Transportation Department, Motor Carrier Services office if this
agreement is terminated. Notification must be in writing, submitted by fax to (208) 334-2006 or by
e-mail to cvs@itd.idaho.gov.
Maintain an active USDOT status classified as an Interstate Motor Carrier and comply with all
USDOT requirements, including timely updates and Unified Carrier Registration (UCR) filings.
Safety Responsible Motor Carrier Authorized Representative's Printed Name Title
Authorized Representative's Signature*
Date
*Cannot be signed by a licensing agent or third-party
Submit the completed and signed statement to:
Mail: Idaho Transportation Department
Motor Carrier Services
For office use only
PO Box 7129
Boise ID 83707-1129
Reviewed By:
Fax: (208) 334-2006
Date:
or
E-mail:
cvs@itd.idaho.gov
ITD 3051 (Rev. 04-13)
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