Form BOC-3 Designation of Agents - Motor Carriers, Brokers and Frei

OMB NO: 2126-0015
EXPIRATION DATE:
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the
Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0015. Public reporting for this collection of
information is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to
this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection
Clearance Officer, Federal Motor Carrier Safety Administration, MC-MMI, Washington, D.C. 20590.

U.S. Department of Transportation
Federal Motor Carrier
Safety Administration

Form BOC-3 Designation of Agents - Motor Carriers,
Brokers and Freight Forwarders

Docket No: MCFFDate:
FULL AND CORRECT NAME OF CARRIER, BROKER OR FREIGHT FORWARDER, AND ADDRESS, INCLUDING ZIP CODE

TITLE OF AUTHORIZED PERSON

TELEPHONE NO. (

SIGNATURE

)

INSTRUCTIONS: Regulations governing the designation of persons upon whom process may be served are prescribed at 49 CFR 366, as amended. An agent must
be designated for each state in or through which the carrier, broker, or freight forwarder operates; each person, association or corporation designated must reside in
the state for which designated; a carrier, broker or freight forwarder may designate himself/herself for the state in which he/she resides; and state officials may be
designated only if such official’s agreement to so act is furnished with this designation. Note: a post office box is NOT ACCEPTABLE as an agent’s address.
FILE THE ORIGINAL signed copy with the FMCSA, 400 Virginia Ave., SW, Suite 600, Washington, DC 20024. One signed copy should be filed with each State
in or through which the operation is conducted; and one copy should be retained by the carrier, broker or freight forwarder.
CHANGES in designation may be made only by filing with the FMCSA, a new form BOC-3. Copies of new designations need to be sent only to those states
affected by the change or new filing. Either INDIVIDUAL or BLANKET designations may be made.

INDIVIDUAL DESIGNATIONS
Pursuant to Section s 13303(a) and 13304(a) of the ICC Termination Act of 1995, the carrier, broker, or freight forwarder named above hereby designates the
following named individuals upon whom service of notices by the Secretary or service of process issued by any court in any action against the carrier, broker or
freight forwarder may be served in the state named. Show agent’s name address (P.O. Box NOT acceptable), City, and zip code for each state in which operations
can be conducted..
Alabama

Georgia

Alaska

Hawaii

Arizona

Idaho

Arkansas

Illinois

California

Indiana

Colorado

Iowa

Connecticut

Kansas

Delaware

Kentucky

District of Columbia

Louisiana

Florida

Maine

(Continued on the reverse side)
INDIVIDUAL DESIGNATIONS (Continued)

Maryland

Ohio

Massachusetts

Oklahoma

Michigan

Oregon

Minnesota

Pennsylvania

Mississippi

Rhode Island

Missouri

South Carolina

Montana

South Dakota

Nebraska

Tennessee

Nevada

Texas

New Hampshire

Utah

New Jersey

Vermont

New Mexico

Virginia

New York

Washington

North Carolina

West Virginia

North Dakota

Wisconsin

Wyoming

BLANKET DESIGNATION
If you have made arrangements with an association or corporation to use the blanket designations on file with the FMCSA, insert the association or corporation
name in the following paragraph:

Pursuant to Sections 13303(a) and 13304(a) of 49 U.S.C., the carrier, broker, or freight forwarder named on the reverse hereby designates those persons named in
the list of process agents on file with the FMCSA by and any subsequently filed revisions thereof, for the states in which the carrier, broker, or freight forwarder is
or may be authorized to operate, including states traversed in the course of such operations, except those states for which individual designations are made.