Please Fill in the Following Information
* Operation Information
INSPECTION NOTIFICATION INFORMATION
Motor Vehicles shall be presented for inspection at the time and place designated by a duly authorized representative Department. The following individual(s) is/are responsible to insure that any required records and vehicle(s) are available Inspection:
ACCIDENT/INCIDENT NOTIFICATION INFORMATION
The following individuals are familiar with the requirements as contained in NYCRR Title 17 Part 722 and are primarily
responsible to report accidents/incidents to the NYDOT.
DULY AUTHORIZED COMPANY REPRESENTATIVE CERTIFICATION:
I am a duly authorized representative of the organization as indicated above. I reviewed the information on this form and to the best of my knowledge find it to be true and accurate.
A-1 Limo & Bus Repair
Nassau Suffolk Limousine Association
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