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Chula Vista

By Andrew Horn | June 10, 2020

450 4th Avenue
Chula Vista, CA 91910

480 4th Ave
Chula Vista, CA 91910

525 3rd Ave
Chula Vista, CA 91910

542 Broadway
Chula Vista, CA 91910

841 Kuhn Dr Ste 101
Chula Vista, CA 91914

855 3rd Ave Ste 2250
Chula Vista, CA 91911

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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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State:*
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Company DOT Name:
DOT #
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 #:*
DER E-mail:*
* DOT pre-employment drug test must be completed before driver is added to random pool.

Step 2: Choose Enrollment Package:
*
- Basic Package ($100)
  - 1-Year Enrollment in Randoms
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  - Paper CCFs or Electronic CCFs
  - $60 Drug Test / $50 Breath Alcohol
- Compliance Package ($300)
  All Benefits of Basic Package plus:
  - 2 Free Drug Tests
  - 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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