"Sightseeing Bus - Usepa Engine Conformity Affirmation" - New York City

Sightseeing Bus - Usepa Engine Conformity Affirmation is a legal document that was released by the New York City Department of Consumer Affairs - a government authority operating within New York City.

Form Details:

  • Released on August 13, 2018;
  • The latest edition currently provided by the New York City Department of Consumer Affairs;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York City Department of Consumer Affairs.

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Download "Sightseeing Bus - Usepa Engine Conformity Affirmation" - New York City

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DEPARTMENT OF CONSUMER
NYC SMALL BUSINESS
AFFAIRS (DCA) LICENSING CENTER
SUPPORT CENTER
42 Broadway, Lobby
90-27 Sutphin Blvd, 4th Floor
New York, NY 10004
Jamaica, NY 11435
Monday-Friday: 9:00 a.m.-5:00 p.m.
Monday-Friday: 9:00 a.m.-5:00 p.m.
Wednesday: 8:30 a.m.-5:00 p.m.
311 (212-NEW-YORK outside of NYC)
nyc.gov/dca | @NYCDCA
SIGHTSEEING BUS –
USEPA ENGINE CONFORMITY AFFIRMATION
Legal Name of Business (Applicant):
Business’s Trade or Doing-Business-As (DBA)
Name, if applicable:
Business Address:
I affirm the following:
1. Each bus listed below is powered by an engine covered by a Certificate of Conformity issued by the
United States Environmental Protection Agency (USEPA).
2. The date of the manufacture of the chassis for each bus is in the model year of the Certificate of
Conformity or an earlier year.
3. For each listed engine I will attach:
a. An original letter from the engine manufacturer stating that the engine serial number is included in
an engine family which is specified. AND
b. A copy of the USEPA Certificate of Conformity for the specified engine family.
4. This affidavit relates to the bus(es) listed below. (Attach additional papers as necessary.)
Bus
Chassis Number
Engine Serial Number
1.
2.
3.
4.
5.
5. If an engine other than the listed engine is installed in any of the corresponding chassis, I will notify DCA
of the change within five business days by filing an updated affirmation with all of the required information
and supporting documentation.
6. I understand that falsification of any statement made herein is an offense punishable by a fine or
imprisonment or both.
_______________________________
___________________________
Signature
Print Name
_______________________________
___________________________
Print Title/Position (if any)
Date
Updated 08/13/2018
DEPARTMENT OF CONSUMER
NYC SMALL BUSINESS
AFFAIRS (DCA) LICENSING CENTER
SUPPORT CENTER
42 Broadway, Lobby
90-27 Sutphin Blvd, 4th Floor
New York, NY 10004
Jamaica, NY 11435
Monday-Friday: 9:00 a.m.-5:00 p.m.
Monday-Friday: 9:00 a.m.-5:00 p.m.
Wednesday: 8:30 a.m.-5:00 p.m.
311 (212-NEW-YORK outside of NYC)
nyc.gov/dca | @NYCDCA
SIGHTSEEING BUS –
USEPA ENGINE CONFORMITY AFFIRMATION
Legal Name of Business (Applicant):
Business’s Trade or Doing-Business-As (DBA)
Name, if applicable:
Business Address:
I affirm the following:
1. Each bus listed below is powered by an engine covered by a Certificate of Conformity issued by the
United States Environmental Protection Agency (USEPA).
2. The date of the manufacture of the chassis for each bus is in the model year of the Certificate of
Conformity or an earlier year.
3. For each listed engine I will attach:
a. An original letter from the engine manufacturer stating that the engine serial number is included in
an engine family which is specified. AND
b. A copy of the USEPA Certificate of Conformity for the specified engine family.
4. This affidavit relates to the bus(es) listed below. (Attach additional papers as necessary.)
Bus
Chassis Number
Engine Serial Number
1.
2.
3.
4.
5.
5. If an engine other than the listed engine is installed in any of the corresponding chassis, I will notify DCA
of the change within five business days by filing an updated affirmation with all of the required information
and supporting documentation.
6. I understand that falsification of any statement made herein is an offense punishable by a fine or
imprisonment or both.
_______________________________
___________________________
Signature
Print Name
_______________________________
___________________________
Print Title/Position (if any)
Date
Updated 08/13/2018