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Mv 427 Penndot Template

The MV-427 form is a crucial document utilized in Pennsylvania for those seeking to establish or modify an inspection station. This form is essential for ensuring compliance with state regulations regarding vehicle safety and emissions inspections. Applicants must complete the form accurately and submit it along with a comprehensive packet of supporting documents to avoid delays or rejections.

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The MV-427 form, administered by the Pennsylvania Department of Transportation (PennDOT), is a crucial document for individuals or businesses seeking to establish or modify an inspection station. This application serves multiple purposes, including applying for a new inspection station, reappointment after suspension, or changing ownership or location. It is imperative that applicants submit a complete station information packet; incomplete submissions will lead to rejection and notification of deficiencies. The MV-427 requires specific documentation, including proof of liability insurance or a bond, copies of utility bills, and photos of the inspection area. Additionally, applicants must provide detailed information about their business, including ownership structure and inspection area dimensions. Each application must be accompanied by a separate form for emissions if applicable, ensuring that safety and emissions inspections are not conflated. Proper completion of the MV-427 not only facilitates the appointment process but also helps maintain compliance with state regulations. As such, attention to detail in this application is essential to avoid delays and ensure operational readiness.

Key takeaways

1. Complete All Required Forms: When applying for a safety inspection station, ensure you fill out the MV-427 form accurately. If you also need an emissions inspection, complete a separate MV-427 form specifically for emissions. Do not check both options on the same form.

2. Gather Supporting Documents: Your application must include various documents. These include proof of liability insurance, a lease or deed, utility bills, and photos of the inspection area. Missing any of these items will result in rejection of your application.

3. Follow Submission Guidelines: Send your completed application packet to the Pennsylvania Department of Transportation. You can mail it or email it to the designated address. Make sure to include all necessary documentation to avoid delays.

4. Understand the Application Purpose: Use the MV-427 form when establishing a new inspection station or making changes to an existing one. This includes changes in ownership, location, or type of inspection services offered. Proper completion will serve as your appointment certificate.

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Documents used along the form

The MV-427 form is essential for applying to become an official inspection station in Pennsylvania. However, it is often accompanied by several other documents that are equally important for a complete application. Below is a list of forms and documents commonly used alongside the MV-427, each serving a specific purpose in the application process.

MV-427A: This supplemental form is required if the applicant is applying for both safety and emission inspection stations. Each type requires a separate form to ensure clarity in the application.
MV-443: This document provides a list of certified safety inspectors associated with the inspection station. It must include the inspector numbers for verification purposes.
Letter of Authority: If a person listed in section E of the MV-427 is not an owner or corporate officer, a separate document must be submitted. This should include their name and driver’s license number.
MV-500: This form may be required for specific applications and provides additional information pertinent to the inspection station's operations.
Copy of Lease or Deed: Providing a copy of the lease agreement or the deed establishes your legal right to operate at the specified location, which is crucial for compliance. You can obtain a suitable lease document from californiadocsonline.com/residential-lease-agreement-form/.
Certificate of Liability Insurance or Bond: Proof of insurance or a bond of at least $10,000 is necessary to cover potential damages during inspections. The document must specify the station's name, location, and coverage details.
Lease or Deed: A copy of the lease or property deed where the inspection station will operate is required to confirm the legitimacy of the business location.
Utility Bills: Recent copies of utility bills, such as electric and phone, must be submitted to verify the operational status of the inspection station.
Photos: Clear photographs of the inspection area, sticker security area, and office must be included to provide visual confirmation of the facility's compliance with safety standards.
Employer Identification Number (EIN) or Social Security Number (SSN): A valid EIN or SSN is required for tax purposes and to ensure proper identification of the business entity.

Each of these documents plays a vital role in the application process for an inspection station. Ensuring that all forms are completed accurately and submitted together can streamline the approval process and help avoid unnecessary delays. Proper preparation is key to a successful application.

Dos and Don'ts

When filling out the MV-427 PennDOT form, there are several important dos and don'ts to keep in mind. Following these guidelines can help ensure a smooth application process.

Do read the instructions carefully before starting the application.
Do complete separate forms for safety and emissions inspections.
Do provide accurate and complete information in all sections.
Do include proof of liability insurance or a bond of at least $10,000.
Do ensure that PennDOT is listed as the Certificate Holder on your insurance.
Do submit the completed packet via mail or email to the correct address.
Don't check both safety and emissions on the same form.
Don't use a post office box as your business address; a physical address is required.
Don't forget to sign the application where required.
Don't submit incomplete applications; this will lead to rejection.

Common mistakes

Completing the MV-427 form can be a straightforward process, but several common mistakes can lead to delays or rejections. One frequent error is failing to submit separate forms for safety and emissions inspections. It is essential to understand that you must complete one form for safety and another for emissions. Checking both boxes on a single form will result in the application being rejected.

Another common mistake involves incomplete documentation. Applicants often overlook the requirement to include a list of certified safety inspectors on form MV-443. This list must include the inspector number, and failing to provide it can lead to the rejection of the entire application packet. Ensuring that all necessary documents are included is crucial for a smooth application process.

Many applicants also neglect to provide accurate insurance documentation. The certificate of liability insurance or bond must clearly state the station name, physical location, and coverage amount. If this information is missing or incorrect, the application will be deemed incomplete. It is important to double-check that all details match what is required by PennDOT.

Providing false or inaccurate information is another significant mistake. If any part of the application contains errors, it can automatically invalidate the certificate. This includes details in Section A regarding the reason for the application or the ownership structure of the business. It is vital to ensure that all information is truthful and correctly filled out to avoid complications.

Finally, applicants often fail to sign the application in the appropriate places. The form must be signed by the owner or a corporate officer at the time of submission. If Section E is completed, the person authorized by the owner must also sign. Missing signatures can lead to automatic rejection of the application, so it is essential to verify that all required signatures are present before submitting the packet.

File Characteristics

Fact Name	Fact Description
Form Purpose	The MV-427 form is used to apply for a new inspection station or to report changes to an existing station.
Separate Applications	When applying for both safety and emission inspections, applicants must submit separate MV-427 forms for each type.
Insurance Requirement	Applicants must provide proof of liability insurance or a bond of at least $10,000 to cover damages during inspections.
Documentation Needed	A complete application packet includes several documents, such as utility bills, a lease or deed, and photos of the inspection area.
Owner Identification	Section E of the form requires identification for anyone operating the station who is not listed as an owner or corporate officer.
Application Submission	Completed applications should be mailed or emailed to the Pennsylvania Department of Transportation's Vehicle Inspection Division.
Governing Law	The application is governed by the Vehicle Code, specifically 75 Pa.C.S. Sections 4721, 4723, and 3368.
Verification Requirement	Applicants must verify that all information provided is true and correct, subject to penalties for false information.
Application Format	The form must be completed in black ink, and all information should be printed clearly or typed to ensure legibility.

Form Sample

Safety Station Application Check List

Upon submission of the station information packet, all items below must be included. If information is incomplete, the packet will be rejected. A letter will be sent to the applicant, notifying them of the deficiency. Additionally, included in the packet is an instruction sheet detailing how to complete form MV-427.

☐MV-427 (If applying for a safety and emission inspection, station must complete one form for safety and a separate form for emission. (Do NOT check both safety and emissions on the same form. One form should only specify SAFETY and the other form, if necessary, should only specify EMISSIONS).

☐MV-427A (must complete two separate forms if applying for a safety and emission inspection station).

☐MV-443 list of certified safety inspectors (include inspector number).

☐If you have completed section E Letter of Authority on form MV-427 and the person listed in section E is not listed on the form MV-427 as owner or is not listed as an owner/corporate officer on form MV-427A, you must include a separate document to provide that person’s name and driver’s license number with the packet. (If you are providing an out-of-state driver’s license number, you must also provide date-of-birth with the information.)

☐MV-500

☐Certificate of liability insurance or bond: Attach proof of insurance or a bond, in the amount

of at least $10,000.00, providing compensation for any damage to a vehicle during an inspection. A

“ Garage Keeper’s Legal Liability Policy” is acceptable. This proof of insurance or bond MUST include station name, physical location, and amount of coverage and period of coverage.

☐Must have a valid insurance policy with PennDOT listed as the Certificate Holder, using the address below

☐Copy of lease or deed

☐Copies of utility bills (most recent electric and phone bill)

☐Photos of the interior and exterior of the inspection area, sticker security area, and office area.

☐Must have a valid Employer Identification Number (EIN) or Social Security Number (SSN)

☐Must have a valid State Sales Tax Number

The completed packet should be mailed/emailed to:

Pennsylvania Department of Transportation

Vehicle Inspection Division

P O Box 68696

Harrisburg, PA 17106-9003

ATTN: Troy Roadcap, Manager

EMAIL: stationappointments@pa.gov

MV- 4 2 7

I NSPECTI ON STATI ON APPLI CATI ON

I NSTRUCTI ONS

USE: This application should be completed when applying for a new inspection station, and when any changes occur to an existing station, such as; change of location, change of ownership, and reappointment after a suspension, etc.

COMPLETI ON OF FORM: When properly completed and approved, this application will serve as your appointment certificate. Please use black ink and print clearly or type. PROVI DI NG FALSE, I NACCURATE, OR I NCOMPLETE I NFORMATI ON WI THI N THE APPLI CATI ON AUTOMATI CALLY I NVALI DATES THI S CERTI FI CATE.

Section A: I ndicate the reason for this application.

•New inspection station: A business which is not currently an inspection station.

•Reappoint After Cancel: A previously cancelled station reopens. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) NOT APPLI CABLE FOR PREVI OUS ENHANCED EMI SSI ON STATI ONS.

•Reappointment after Suspension: A business that had its inspection privileges suspended and wishes to reopen as an inspection station after the suspension has been served.

•Change of Location: An existing inspection station that is moving to a new location or is remodeling the existing location to provide additional space.

•Change of Ownership: When a new owner(s) takes over an existing inspection station or when a corporation changes President and the person was never listed as a Corporate Officer in the past. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” )

•Change of Authority: When a person in charge of an inspection station changes, but the ownership of the company remains the same. ( Section E should be completed at this time.)

•Change of Mailing Address: When a business wants to update an existing mailing address that is different than the physical location.

•Add Mailing Address: When a business wants its mail to be delivered to an address other than the physical location of the garage. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

•Delete Mailing Address: when a business wants to delete an existing mailing address other than its physical location. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

•Change of address by Post Office: When the business address of the station is being changed by the United States Post Office, or other agency.

•Company to Corporation: A sole proprietorship or partnership incorporates. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

•Change of Trade Name: An existing inspection station making a name change only. (See Company to Corporation above it the station is incorporating) .

•Adding or changing a station type: When a general station adds motorcycle, a fleet station changes to a general station and vice versa. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

•Add or Drop Partner: When a business adds or drops a partner(s) . (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

Section B: Complete this section with the following information.

•Business name: I ndicate the name under which you will operate. (list both names is you trade under a

different name; ie. Smith’s Garage, inc. T/ A Mike Smith Automotive.

•Business address: I ndicate the actual location of the business. Must be a street address, no post office boxes in this space. I f you want to use a PO Box, complete the mailing address box in this section.

•Telephone number: Provide the business telephone number including area code.

• Ow ner’s name: List the owner of the business. I f business is a partnership list on partner. I f the business is a corporation, list a corporate officer. A regional or district manager is also acceptable.

•Driver License# : Provide the owner’s driver’s license number. I f license is issued from a state other than

Pennsylvania, please list the correct state abbreviation after the operator number: e.g., 123038483949 NJ (for operator number from New Jersey) .

•Mailing address ( if different from the business address) : May be indicated in the space provided. I f you wish to receive mail from the Department at your business address, the mailing address segment of Section B should remain blank.

Section C: This section provides additional information about your business.

•I ndicate if you are the sole proprietor, a partnership, or a corporation. (Commonwealth stations should check corporation) .

•I ndicate your Federal I D number and Sate Sales Tax number in the appropriate boxes. I f you have submitted applications to these agencies and have not received your identification numbers, you may write “ APPLI ED FOR” in the appropriate boxes, and then submit your number(s) to the Department when they are received.

•I ndicate the size of the I nspection area where inspection are performed (ie. 22ft x 28 ft or if more than one bay, e.g., Bay 1 22ft x 28 ft Bay 2 22ft X 62 ft, etc.)

•I ndicate the one category most appropriate for your business.

•I ndicate the type(s) of station you wish to operate which should coincide with the type(s) of vehicles you will be inspecting. I f applying for a safety station and an emission station you must complete a separate application for each type. (Do not mark safety and emission on the same application) .

•I ndicate the type(s) of station you wish to operate and check the appropriate box(es) for any type(s) of vehicles you will be inspecting at your business.

Section D: First section should be completed when you own another inspection station. Second section should be completed when you need to cancel a previous inspection station.

•First Section – Provide the station number(s) of other station(s) you own.

•Second Section – Provide the current station number and/ or name of station being cancelled due to change of location, change of ownership or change of station type, ie. Fleet to General.

Section E: This section should be completed by the owner or a corporate officer ONLY when a person OTHER THAN an owner or a corporate officer is responsible for operating the business in the owner/ corporate officer’s behalf.

I MPORTANT: PRI NT ALL PARTS OF SECTI ON E, EXCEPT for the signature of the owner/ corporate officer.

Section F: DO NOT WRI TE I N THI S SPACE.

Section G: The application must be signed by the owner/ corporate officer at the time of application submission. I N THOSE CASES WHERE SECTI ON E HAS BEEN COMPLETED, THE PERSON AUTHORI ZED BY THE OWNER/ CORPORATE OFFI CER MUST SI GN THE APPLI CATI ON.

MV-427 (2-08)

INSPECTION STATION

FORDEPARTMENTUSEONLY

PLEASE TYPE OR PRINT CLEARLY.

CERTIFICATE OF

INCIDENT# ____________________________

THIS APPLICATION WILL SERVE AS

APPOINTMENT

YOUR CERTIFICATE

CHECK ✔ THE PROPER BLOCK:

❑New Inspection Station

❑Re-appointment after suspension

❑Change of Location

❑ Change ofAuthority within a Company or a Corporation

❑Change of MailingAddress

❑Change ofAddress by Post Office

❑ Change of Trade Name

❑ Other

NAME AND ADDRESS OF BUSINESS

Name of Business

Business StreetAddress

City

County

State

Zip Code

Telephone #

Owner’s Name

Driver’s License #

MailingAddress (if different than above)

City

County

State

Zip Code

BUSINESS INFORMATION

CHECK ✔ OWNERSHIP CLASS:

❑Sole Proprietorship (A)

❑ Partnership (B) ❑Corporation (C)

Federal ID #

State Sales Tax #

Size of InspectionArea

Category ✔ Check One:

❑Garage (A)

❑Manufacturer (E)

❑Gas Station (B)

❑New Dealer (C)

❑Used Dealer (D)

Station Type: ❑Motorcycle (A)

❑Fleet (C)

❑General (E)

❑Enhanced Safety

❑Commonwealth (F)

❑Emission (X)

❑Trailer (D)

Inspection (J)

Type of vehicles you will be inspecting:

❑Passenger Cars

❑Light Trucks

❑Trailers 10,000 lbs or less

❑Trucks over 17,000 lbs.

❑ Buses

❑Motorcycles

❑Trailers over 10,000 lbs.

❑Trucks 17,000 lbs. or less

Station number of other Station(s) presently owned:

Station number and/or name of current Inspection Station:

LETTER OF AUTHORITY

CERTIFICATION

Thisletterauthorizes_______________________________________

Certificate ofAppointment as an Official Inspection Station

(Print Name of person signing the application)

Pursuant to the provisions of the Vehicle Code, 75 Pa.C.S. Sections 4721,

4723 or 3368,Act of June 17, 1976, No. 81, as amended.

________________________________________________________

(Title)

residing at _______________________________________________

(home street address)

________________________________________________________

(NOT VALID WITHOUT SEAL)

(city/town)

(county)

(state)

(zip)

to be responsible for all inspection operations performed at the above

station.

_______________________________________ _______________

This certificate may be suspended or cancelled at any time if the provisions

of the Vehicle Code or the inspection regulations are not being complied

(Signature of owner or officer)

(Date)

with or if the business is being improperly conducted.

_______________________________________

Any change at a designated Official Inspection Station automatically

(Title)

invalidates this Certificate.

Application Date:

Appointment Date:

Inspection

Station #

Iverifythatthefactssetforthonthisapplicationwerecheckedafterthecompletionoftheformandaretrueandcorrect.Thisverificationismadesubject

to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S. § 4904) relating to Unsworn falsification to authorities.

Applicant Signature:

Title

Department Investigator:

Troop/Station

Badge #

WHITE - Business Copy

YELLOW - Bureau of Motor Vehicles Copy

PINK - Investigator Copy

MV-427A (4-12)

Station Application

Supplemental Information

For Department Use Only

ATTACHMENT 1

PLEASE TYPE OR PRINT CLEARLY

A.STATION NAME: _____________________________________________________________________________________

B.INSURANCE ACKNOWLEDGEMENT:

I understand that a bond or certificate of insurance in the amount of $10,000 is required for each inspection station. I also understand that failure to maintain this bond or insurance will result in cancellation of my inspection station.

Yes ______ No ______

C.ADDITIONAL INFORMATION:

1.LIST ALL OWNERS, PARTNERS OR CORPORATE OFFICERS (NOTE: Individuals should list thier PA Driverʼs License (PA DL) or Photo ID# in the space provided. Business should list their Business ID# (Bus.ID) where indicated (i.e. E.I.N.)

NAME	TITLE	PA DL/PHOTO ID#	DATE OF BIRTH

STREET ADDRESS	CITY	STATE	ZIP

NAME	TITLE	PA DL/PHOTO ID#	DATE OF BIRTH

STREET ADDRESS	CITY	STATE	ZIP

NAME	TITLE	PA DL/PHOTO ID#	DATE OF BIRTH

STREET ADDRESS	CITY	STATE	ZIP

NAME	TITLE	PA DL/PHOTO ID#	DATE OF BIRTH

STREET ADDRESS	CITY	STATE	ZIP

2.Has this business or the owners, partners or officers thereof ever been a dealer, miscellaneous motor vehicles business, messenger service, inspection station or issuing agent in this or any other state?

Yes _____ No _____

If yes, list name(s), location(s), and identification number(s).

_________________________________________________________________________________________________

3.Is this application for a change of ownership or was this location previously an inspection station?

Yes _____ No _____

If yes, list previous station name(s), address(s) and identification number(s).

_________________________________________________________________________________________________

4.Is this inspection station being sold, transferred or leased while the station is suspended or restored pending appeal?

Yes _____ No _____

If yes, were you ever affiliated with this station or are you related in any way to the owner(s)? Yes _____ No _____

5.Have any owners, partners or corporate officers of this business been affiliated with a dealership, miscellaneous motor vehicle business, messenger service, inspection station or issuing agent whose privilege to conduct business as such was suspended, cancelled or revoked or is currently under investigation or received notice to attend a Departmental or court hearing or is awaiting a decision by a hearing officer or a Court?

Yes _____ No _____

If yes, list name, location, and identification number and explain situation.

_________________________________________________________________________________________________

6.Does any owner, partner, corporate officer or any business with which they were previously affiliated, have any outstanding liabilities which are due and owing to the Commonwealth, including but not limited to, taxes, fees, monetary penalties or outstanding paperwork?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

7.Have any owners, partners or corporate officers of this business ever been convicted or administratively sanctioned for violations of Department regulations Chapter 175 or 177 or Chapter 47 of the Vehicle Code?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

8.Have any owners, partners or corporate officers of this business ever remitted uncollectible checks payable to the Department of Transportation or the Commonwealth of Pennsylvania?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

9.Are all owners, partners, officers and management/supervisory employees aware of their responsibilities and obligations relating to the operation of an official inspection station, including but not limited to, record keeping, supervision of employees and customer relations?

Yes _____ No _____

If no, explain

_________________________________________________________________________________________________

I hereby verify that the information set forth above is true and correct to the best of my knowledge, information and belief. This verification is made subject to the penalties of 18 PA. C.C.§4904, relating to unsworn falsification of authorities.

Signature: _________________________________________________________________________________________

Print Name as it Appears Above: _______________________________________________________________________

Title: ________________________________________________________________________________________________

Date: _______________________________________________________________________________________________

MV-443 (3-06)

Commonwealth of Pennsylvania

DEPARTMENT OF TRANSPORTATION

OFFICIAL INSPECTION STATION NUMBER _____________________________

CURRENT LIST OF CERTIFIED

SAFETY INSPECTION MECHANICS

	OPERATOR’S	MECHANIC
NAME	LICENSE	CERTIFICATION	CLASS
NAME			CLASS
	EXPIRATION	EXPIRATION
	DATE	DATE

1.____________________________________________________________________________________

2.____________________________________________________________________________________

3.____________________________________________________________________________________

4.____________________________________________________________________________________

5.____________________________________________________________________________________

6.____________________________________________________________________________________

7.____________________________________________________________________________________

8.____________________________________________________________________________________

9.____________________________________________________________________________________

10.___________________________________________________________________________________

11.___________________________________________________________________________________

12.___________________________________________________________________________________

13.___________________________________________________________________________________

14.___________________________________________________________________________________

15.___________________________________________________________________________________

16.___________________________________________________________________________________

17.___________________________________________________________________________________

MV-500 (11-10)

www.dot.state.pa.us

Bureau of Motor Vehicles

Vehicle Inspection Division

P.O. 68697 • Harrisburg, PA 17106-8697

Pennsylvania Department of Transportation Authorized Agents for Purchasing Stickers

r NEW

r REVISED (PLEASE CHECK ONE)

	PRINT NAME AS LISTED ON ID		OPERATOR NUMBER		SOCIAL SECURITY#
	OR DRIVER’S LICENSE				(IF NON-PA DRIVER’S LICENSE)
	OR DRIVER’S LICENSE
1.	_____________________________	1.	_____________________________	1.	_____________________________
2.	_____________________________	2.	_____________________________	2.	_____________________________
3.	_____________________________	3.	_____________________________	3.	_____________________________
4.	_____________________________	4.	_____________________________	4.	_____________________________
5.	_____________________________	5.	_____________________________	5.	_____________________________

I hereby authorize the above listed person(s) to sign sticker requisitions and receive Certificates of Inspection for the following Official Inspection Station:

__________________	__________________________________	________________________
(Station Number)	(Station Name)		(Telephone #)
______________________________________________________________			____________________
(Signature of Station Owner or Authority) - Station Owner or Authority must be listed in one of the five lines above.			(Title)
______________________________________________________________			____________________
(Print Name As It Appears Above)			(Date)

REVIEW INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING.

THIS FORM MAY NOT BE COPIED OR FAXED

•Official Inspection Stations must use this form to authorize purchaser(s) to sign Form MV-436A, "Inspection Sticker and Insert Order Form."

•You may submit up to five names to be placed in a computerized signature file for your station. (NO MORE THAN FIVE (5) NAMES ARE PERMITTED). Each name submitted must include, driver’s license number (or government issued photo identification card number) and Social Security number (if non-PA driver’s license).

•If the station owner or authority (as listed in sections B or E of the certificate of appointment Form MV-427) or corporate officer, partner, etc. (listed on Form MV-427A) intends to sign Form MV-436A to purchase inspection stickers, his/her name, operator number, and Social Security Number

(if applicable) must also be listed on one of the five (5) designated spaces.

•If the REVISED box is checked, you will need to list all persons whom you have previously authorized and wish to remain authorized. Any names that are not on this form will be deleted from the computerized signature file.

•Stations which are appointed to perform both safety and emission inspections may submit only one (1) authorization form. The authorized purchasers for these stations will be able to sign Form MV-436A for both safety and emission stickers.

•Bonded messengers and members of the Legislature cannot be listed on this form as authorized purchasers.

•Return this form to: Bureau of Motor Vehicles, Vehicle Inspection Division, P.O. Box 68697, Harrisburg, PA 17106-8697. If you have questions please call (717) 787-2895.