FLEET INFORMATION FORM

Business Name:     					Parent Company Name:     				 Carrier ID#:      		
Company Address:      							City:      								
State:      				 Zip:      			
Contact Name:      					Contact Title:      									
Tel: (     )     			 Fax: (     )     			Email:      							
1.	Are you a:
 Private Fleet		 Government Fleet		 Government-Contracted Fleet 
2.	How would you describe your business or activity sector?
 Trucking-Motor Carrier	 Trucking-Owner/Operator	  Agriculture		
 Commercial			 Construction 			  Industrial				
3.	How many locations do you operate from?       		
4.	In which California counties do you operate?       		
5.	What is your on-road heavy-duty (8,500 lbs. GVWR and above) fleet size for all locations combined?        		
6.	What is your off-road heavy-duty (50 HP and above) fleet size for all locations combined?        		
7.	How do you typically acquire your equipment? 
 Purchase new	 	 Purchase used		 Lease 	 Rent
8.	Fill out the following table for each of your fleet locations
Terminal ID #	Address	City	State	Zip Code	

					

9.	Where do you refuel your equipment? Please check all that apply.
 Fleet-owned Station 		 Job-site Fueling Service (Wet-hosing)	 Retail/Truck Stop	 Other, Fill in:     		
10.	Do you currently have access to Ultra Low Sulfur Diesel fuel (< 15ppm sulfur)?
 Yes			 No
11.	What percentage of your vehicles/equipment operates solely in California and what percentage also operates outside of California?
Only within California:       % 		Also outside of California:      %
12.	What would you consider as an incentive to retrofit your vehicles/equipment with low-emission devices before they are required?  Please check all that apply.
 Green image		 Government Grants	 Tax Incentives, Explain:     				 Other, Fill In:     					

Fill out the following with an entry for each vehicle/equipment in your fleet.  See the next page for table header explanations. Please make copies as necessary.

Vehicle Type  (1)	Application Type (2)	Equipment Make (3)	Equip/Veh Model (4)	Equip/Veh Model Year (5)	GVWR (6)	Engine Mfr. (7)	Engine Model (8)	Engine Model Yr. (9)	HP (10)	Disp. (11)	Fuel Type (12)	Mech/ Elect (13)	Asp. (Diesel only) (14)	Aux Eng Y/N (15)	Odo- or Hourmeter Reading (16)	Annual Fuel Use (17)	Annual Mileage or Hours (18)	Year of last Rebuild (19)	License Plate Number (20)	
Conventional Small Sleeper	Delivery	International	9400i	1993	42,000	CAT	3406C	1993	425	14.6 L	Diesel	Mech.	Turbo	N	572,000 miles	12,000 gallons	60,000 miles	1998		
Rubber Tired Loader	Construction	CAT	9506	2000	N/A	CAT	3126	2000	180	7.2 L	Diesel	Mech.	Turbo	N	580 hours	2,800 gallons	580 hours	N/A		

																				

																				

																				

																				

																				

Header Explanations				
				
(1) Enter the vehicle or equipment type.  The following tables provide equipment type examples	
				
Onroad Vehicles				
Vehicle Type	Sleeper/Body	Vehicle Type	Sleeper/Body	
Tandem Axle Tractors	Conventional Small Sleeper	Specialty Trucks	Dump Truck/ Bottom Dump/ End Dump	
	Conventional Large Sleeper		Straight Truck	
	Conventional Hi-Rise Sleeper		Flatbed Truck	
	Fleet Quality Truck		Toters	
	Conventional Day Cab		Stakebed with sides	
	Cabover Small Sleeper		Bobtail Truck	
	Cabover Large Sleeper		Tanker Trucks	
	Cabover Hi-Rise Sleeper		Cement Mixer Truck	
	Cabover Day Cab		Roll-off Chassis Truck	
Single Axle Tractors	Sleeper		All purpose Rubbish Chassis Truck	
	Conventional Day Cab			
				
Offroad Equipment 				
Category	Equipment	Category	Equipment	
Agricultural	Mowers	Construction (continued)	Excavators	
	Balers		Graders	
	Combines		Off-highway Tractors	
	Hydro Power Units		Off-highway Trucks	
	Irrigation Pumps		Pavers	
	Sprayers		Paving Equipment	
	Swathers		Rollers	
	Tillers		Rough Terrain Forklifts	
	Tractors		Rubber Tired Dozers	
	Other		Rubber Tired Loaders	
Commercial	Air Compressors		Scrapers	
	Generator Sets		Signal Boards	
	Gas Compressors		Skid Steer Loaders	
	Pressure Washers		Surfacing Equipment	
	Pumps		Tractors/Loaders/Backhoes	
	Welders		Trenchers	
Construction	Bore/Drill Rigs		Other	
	Concrete/Industrial Saws	Industrial	Aerial Lifts	
	Cranes		Forklift	
	Crawler Tractors		Sweeper/Scrubber	
	Crushing/Proc. Equipment		Other General Industrial Equip	
	Dumpers/Tenders		Other Material Handling Equip	
				
(2) Application Type: Enter how the vehicle is used, i.e.rear loader refuse hauler, lube truck, etc…	
(3) Equipment Make: Enter the chassis manufacturer, i.e.: Caterpillar, Case, Deere or Freightliner, International, Kenworth, Mack, Peterbilt, etc…	
(4) Equipment/Vehicle Model: Enter the vehicle/equipment model name, i.e.: 9506, 590 Super M, 9126 or FL112, 9400I, T2000, CH602, Model 357, etc…	
(5) Equipment/Vehicle Model Year: Enter the vehicle/equipment model year.	
(6) GVWR: If applicable, enter the vehicle’s Gross Vehicle Weight Rating. Only enter information for vehicles with GVWR equal or above 8,500 lbs GVWR.	
(7) Engine Mfr.: Enter the engine manufacturer; i.e.: Caterpillar, Cummins, Case, Detroit Diesel, International, John Deere, Mack, etc…	
(8) Engine Model: Enter the engine model name, i.e.: 3126,  4T-390, 6081H, etc…	
(9) Engine Model Yr.: Enter the engine model year.	
(10) HP Range: Enter the engine’s horsepower range.	
(11) Disp.: Enter the engine’s displacement in liters; i.e.: 5.9 liters, etc…	
(12) Fuel Type: Enter the name of the fuel used in the vehicle/equipment, I.e.: Diesel, Dual Fuel (Diesel/LNG or Diesel/ other fuel), Gasoline, Propane, etc…	
(13) Mech./Elect.: Enter "Mech." if the engine is mechanically controlled and "Elect." if the engine is electronically controlled.	
(14) Aspiration: For diesel engines only.  Enter "Nat." if the engine is naturally aspired and "Turbo" if the engine is turbocharged.	
(15) Aux. Eng.: Enter "Y" if your vehicle/equipment has an auxiliary engine and "N" if it does not.	
(16) Odometer or Hourmeter Reading: Enter the mileage value indicated by the vehicle/equipment odometer or the hour vaue indicated by the hourmeter.	
(17) Annual Fuel Use: Enter the average amount of fuel the vehicle/equipment uses each year.	
(18) Annual Mileage or Hours: Enter the engine operating hours or annual mileage per year for this vehicle or piece of equipment.	
(19) Year of Last Rebuild: Enter the year the engine was last rebuilt (in- or out-frame).	
(20) License Plate umber: Enter if applicable the vehicle license plate number	

Contractor/Vendor List

Please enter the names and contact information for all your contractors and vendors with heavy-duty vehicle and equipment fleets

Business Name	Service Provided	Contact Name	Street Address	City	State	Zip	Telephone