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2. Secured Transportation Service License Application Checklist

   Secured Transportation Service - One for Each Company

   1. Application for Secured Transportation Service License
   2. Copy of Certificate of Insurance showing General and Professional Liability coverage and Worker's Compensation Coverage.
   3. Information Regarding Staff
   4. Application Fee
4. Copy of the following written policies and procedures

   1. General Policies and Procedures following National Best Practices Guidelines
   2. Staff Background Check Policy
   3. Class A Licenses: a policy which addresses physical restraint
   4. Client Rights Policies and Procedures
   5. Quality Management Program Policies and Procedures
   6. All other written policies or procedures, including any operational protocols, medical protocols, training procedures, and other relevant documents.
6. Name of Secure Transportation Service:
8. Physical/ Mailing Address
10. City
11. State
12. Zip Code
14. Manager Name
15. Office Phone Number
17. Cell Phone Number
18. Email
20. Type of License:

    1. Class A (may use restraints)
    2. Class B (no restraints)
22. Secured Transportation Service List of Vehicles to be permitted -MUST FILL OUT A SEPARATE PERMIT APPLICATION FOR EACH VEHICLE-(Please include Vehicle Make & Model, Year, Type of Permit Sought 1 - Partitioned or 2- Non- Partitioned)

24. The undersigned acknowledges that the License granted pursuant to this application is not transferable. In the event that the Secure Transportation Service is sold or transferred, the new owner will be required to obtain licensing and permits before beginning operations.

    The undersigned herby affirms that the Secure Transportation Serice complies with all applicable laws and regulations required to operate a secure transportation service in Colorado.  The undersigned represents that he/she has the authority to act on behalf of the Secured Transportation Service, and all information in this application and accompanying documentation is true and accurate to the best of his/her knowledge.

26. Name
27. Date
29. Title
33. Secure Transportation Staffing Requirements
    -- Select One --Class AClass B

    Refer to Part 7, 6 CCR 1011-4: Standards for Secure Transportation Services:

    Class A must complete the training requirements set for Part 7.7(A)(1), (2) & (3)

    Class B must complete the training requirements set for in Part 7.7 (A)(1) & (2)

    Each Staff person must be identified below.

34. Additional Staff Members may be submitted in the same format as required below.
36. Employee Name
38. Valid Driver's License? (Required by all Staff)
    -- Select One --YesNo
39. Background Check Completed? (Required for all staff)
    -- Select One --YesNo
41. Any background check issues? If yes, attach details regarding compliance with Part 7.6., 6 CCR 1011-4.
    -- Select One --YesNo
42. Certification received for training requirements set forth in Part 7.7, 6 CCR 1011-4?
    -- Select One --YesNo
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

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