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Centennial

By Andrew Horn | June 5, 2020

10909 E Arapahoe Pl
Centennial, CO 80112

11877 E Arapahoe Rd
Centennial, CO 80111

20270 E Smoky Hill Rd
Centennial, CO 80015

20971 E Smoky Hill Rd
Centennial, CO 80015

2305 E Arapahoe Rd
Centennial, CO 80122

7375 East Arapahoe Road
Centennial, CO 80112

7384 S Alton Way
Centennial, CO 80112

8006 E Arapahoe Rd
Centennial, CO 80112

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DOT Consortium Program Enrollment Form

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Company Name:*
Step 1: Contact Information:
Contact Name:*
Address 1:*
Address 2:
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Company DOT Name:
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Consortium Type: Check 1 box only, Designated Employee Representative (DER) information is required*
*
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- Company with 100 or more Drivers for a Stand-Alone Random Pool
Owner Operator:*
Driver Name:*
Driver SSN or Employee ID:*
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DER Cell #:*
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* DOT pre-employment drug test must be completed before driver is added to random pool.

Step 2: Choose Enrollment Package:
*
- Basic Package ($100)
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  - Paper CCFs or Electronic CCFs
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- Compliance Package ($300)
  All Benefits of Basic Package plus:
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  - DOT Policy
  - Required Supervisor Training
  - Part 40.25 Form (Required for all drivers)
Optional Add On
*
- 2 Additional Years of Enrollment ($100)
- Part 40.25 Form ($25)
- Supervisor Training ($50/each)
- Paper Copies of 49 CFR Part 40 & 382 ($25)
- DOT Policy ($75)
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- No Additional Add-Ons = $0.00
All fees must be remitted with this form.
Add all columns on front and back on this form.
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