"Charter Service Pre-approval Request Form" - Tennessee

Charter Service Pre-approval Request Form is a legal document that was released by the Tennessee Department of Transportation - a government authority operating within Tennessee.

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Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Tennessee Department of Transportation.

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Charter Service Pre-Approval Request Form
According to the State Management Plan, agencies must obtain pre-approval from TDOT prior
to performing a charter exception as identified in 49 CFR Part 604. The Charter Service Pre-
Approval Request Form should be used for the following three charter exceptions.
GO – Government Officials on Official Government Business
QH - Qualified Human Service Organizations For The Purpose of Serving Persons with Mobility
LE - Leasing FTA-Funded Equipment and Drivers imitations Related to Advanced Age,
Disabilities, and Low Income
If you are interested in performing a charter exception under the WN charter exception (When
No Registered Charter Provider Responds to Notice from a Recipient), you do not have to use
this form. However, you will need to cc TDOT (TDOT.MultimodalAdmin@tn.gov) on the email
notification that is sent to all registered charter providers informing them of the request.
Agency Name:
Date of Service:
Type of Exception (GO, QH, or LE):
Group/Organization Name, Address, Phone Number, and Email Address:
Number of Passengers (Estimate if needed):
Number of Vehicles Needed:
Trip Origination:
Charter Service Pre-Approval Request Form
According to the State Management Plan, agencies must obtain pre-approval from TDOT prior
to performing a charter exception as identified in 49 CFR Part 604. The Charter Service Pre-
Approval Request Form should be used for the following three charter exceptions.
GO – Government Officials on Official Government Business
QH - Qualified Human Service Organizations For The Purpose of Serving Persons with Mobility
LE - Leasing FTA-Funded Equipment and Drivers imitations Related to Advanced Age,
Disabilities, and Low Income
If you are interested in performing a charter exception under the WN charter exception (When
No Registered Charter Provider Responds to Notice from a Recipient), you do not have to use
this form. However, you will need to cc TDOT (TDOT.MultimodalAdmin@tn.gov) on the email
notification that is sent to all registered charter providers informing them of the request.
Agency Name:
Date of Service:
Type of Exception (GO, QH, or LE):
Group/Organization Name, Address, Phone Number, and Email Address:
Number of Passengers (Estimate if needed):
Number of Vehicles Needed:
Trip Origination:
Trip Destination:
Total Trip Mileage (Estimate if needed):
Total Trip Time in Hours (Estimate if needed):
Fee to Be Collected if Performed:
Purpose/Description of Service:
If an LE charter exception is being requested, please attach the following with your pre-
approval request:
• Documentation to show private charter operator is on the FTA charter registration
website,
• Documentation to show the registered charter provider owns and operates vehicles in a
charter service business
• Documentation to show that the registered charter provider received a request for
charter service that exceeds its available capacity by the number of vehicles
• Documentation to show that the register charter provider has exhausted all of the
available vehicles of all registered charter providers in the geographical service area
• List of public transit agency vehicles (by type and VIN) that is requested to be leased to
private charter operator to fulfill request
For TDOT Use
☐Approved
☐Denied
Date:
Comments:
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