The California DCA GSR-1 form is the application used for Gold Shield Station Certification, allowing licensed Smog Check Test-and-Repair stations to offer state-subsidized emissions-related repairs. To qualify, stations must meet specific performance criteria and adhere to regulatory requirements set by the Bureau of Automotive Repair. Completing this form accurately is essential for certification; take the first step by filling it out today.
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The California DCA GSR 1 form is an essential document for Smog Check stations aiming to achieve Gold Shield certification. This certification allows stations to provide state-subsidized emissions-related repairs and certify vehicles identified as gross polluters. The application process is straightforward, requiring no fees, but it is crucial to read all instructions and qualification requirements carefully. Stations must complete the form accurately, providing details such as ownership type, license number, and contact information. Additionally, the form includes questions regarding any past legal issues that could affect eligibility. Successful applicants must meet specific performance criteria, including a minimum number of successful emissions repairs and compliance with various regulatory standards. Failure to meet any requirement can lead to a deficient application, necessitating reapplication in the following quarter. The GSR 1 form serves not only as an application but also as a commitment to uphold the standards set by the Bureau of Automotive Repair, ensuring that certified stations contribute positively to California's air quality efforts.
Bureau of Automotive Repair
Licensing Unit – Gold Shield Program
10240 Systems Parkway, Sacramento, CA 95827
P 916.255.3145 F 916.255.4482 |
www.smogcheck.dca.ca.gov
GOLD SHIELD STATION CERTIFICATION APPLICATION
INSTRUCTIONS:
1.There is no fee required with this application.
2.Read all information contained on this application including the Gold Shield Qualification Requirements (GSR-2).
3.Complete and sign the application.
4.Mail the completed application to the address above.
Please note: This application is only valid for the quarter in which you’ve applied.
STATION NAME
PHONE NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
CA
SMOG CHECK STATION
OWNERSHIP TYPE:
OWNER(S) NAME(S):
____________________________
LICENSE NUMBER:
SOLE PROPRIETOR
PARTNERSHIP
________________
CORPORATION
LLC
Gold Shield stations shall provide the following services to the public:
• State subsidized emissions-related repairs, except stations located in a Change of Ownership area.
• Certification of vehicles identified as gross polluters.
• After repair certification of vehicles that were directed to, initially tested, and failed inspection at a Test-Only station.
• Inspections for new and used car dealers on vehicles registered in Enhanced areas that have been wholesaled to car dealers who subsequently offer them for retail sale in Basic and Change of Ownership areas.
• Initial inspection of vehicles directed to Test-Only station.
Please answer the following questions. If “YES,” please provide an explanation in the space provided; attach additional paper if necessary.
Have you or any of your partners, corporate officers, directors, trustees, LLC members, or your Smog Check station managers or technician(s),
1.
Ever been convicted of a crime?
(For the purposes of this question, “crime” does
YES
NO
not apply to minor traffic violations.)
2.
Been found liable in a civil proceeding for any act or any omission as an Automotive Repair
Dealer, Smog Check Station, or Smog Check Technician, or in a related business?
3.
Ever had any license denied, suspended, revoked, or placed on probation by the Bureau of
Automotive Repair?
4.
Been issued a citation by the Bureau of Automotive Repair within the last year?
GSR-1 (Rev. 12/08)
C:\Documents and Settings\hqsarms\My Documents\Dev\PUB
WEB\gs_app.doc
IMPORTANT INFORMATION:
YOU MUST PASS ALL THE REQUIREMENTS TO BE CERTIFIED AS A GOLD SHIELD STATION. FAILURE TO MEET ANY ONE OR MORE OF THE REQUIREMENTS WILL RESULT IN A DEFICIENT APPLICATION AND YOU WILL RECEIVE A NOTICE LISTING THE DEFICIENCIES. IF YOU RECEIVE A DEFICIENCY NOTICE FOR REQUIREMENTS 1, 2, 3, OR 8 AND HAVE CORRECTED THE DEFICIENCY, YOU MUST REAPPLY AT THE BEGINNING OF THE NEXT QUARTER.
BE ADVISED OF THE FOLLOWING:
•IF THE DEFICIENCIES ARE FOR REQUIREMENTS 1- 3, YOU MUST REAPPLY AT THE BEGINNING OF THE NEXT QUARTER.
•IF THE DEFICIENCY IS FOR REQUIREMENT 4, YOU MUST REAPPLY AFTER THE ONE-YEAR TIME FRAME FROM THE DATE OF YOUR CITATION.
•IF THE DEFICIENCY IS FOR REQUIREMENTS 5-6, YOU MUST REAPPLY AFTER THE THREE-YEAR TIME FRAME FROM THE DATE OF ACTION.
•IF THE DEFICIENCY IS FOR REQUIREMENT 7, YOU MUST REAPPLY UPON THE DECISION OF YOUR HEARING ON THIS MATTER.
•IF THE DEFICIENCY IS FOR REQUIREMENT 8, YOU MUST REAPPLY AT THE BEGINNING OF THE NEXT QUARTER.
I understand that my station will be evaluated according to the qualification requirements.
I certify under penalty of perjury under the laws of the State of California that all statements made in this application and all the attached supporting documents pertaining to this application are true and correct.
SIGNATURE (all partners and all members of a LLC must sign)
TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,
DATE
LLC Member, etc.)
SECTION BELOW FOR BUREAU OF AUTOMOTIVE REPAIR USE ONLY
ENHANCED AREA STATION
BASIC AREA STATION
CHANGE OF OWNERSHIP AREA STATION
MET GOLD SHIELD PERFORMANCE CRITERIA
INITIAL
PASSED ENFORCEMENT RECORD CHECK
REAPPLY DATE
PASSED QUALITY ASSURANCE INSPECTION
FINAL APPROVAL
GOLD SHIELD QUALIFICATION REQUIREMENTS
A licensed Smog Check Test-and-Repair station seeking Gold Shield certification shall complete and file a Gold Shield Station Certification Application form (GSR-1 (Rev. 07/08)) and shall, as of the date the application is received by the Bureau of Automotive Repair, meet all of the following eligibility requirements:
1.The station’s Comparative Failure Rate (CFR) over the preceding quarter must meet or exceed the industry-wide failure rate for Test-Only stations, by Smog Check Program area, as calculated quarterly by the Bureau.
2.The station must have conducted a minimum of 10 successful emissions repairs in the preceding quarter. For the purposes of this section, a “successful emission repair” means:
A.The vehicle must have failed the emissions portion of a Smog Check in official test mode or pre-test mode at any Smog Check station within 60 days prior to the repair;
B.The Smog Check station must have repaired the vehicle and entered repair data into the Vehicle Information Database; and
C.The vehicle must have been issued a Certificate of Compliance at any Smog Check station within 10 days following the repairs made by the applicant Smog Check station.
3.The station’s repair performance in the preceding quarter must rate within the top 75% of test-and-repair stations in the same Smog Check Program area. A station’s repair performance is computed by comparing the final emission readings of each successful emission repair to the average passing emission readings for the same model-year and emission standards category of the vehicle repaired.
4.The station must not have been issued any citations pursuant to Section 44050(a) of the Health and Safety Code within the preceding one-year period, nor employ any technicians who have been issued any citations pursuant to Section 44050(b) of the Health and Safety Code within the preceding one-year period. Click here to verify a license.
5.Neither the current nor any previous registration nor license of the station owner, manager or licensed Smog Check technicians employed by the station:
•Been issued an order of suspension, a probationary order, or any other disciplinary order within the preceding three-year period. Be currently subject to suspension, probation or other disciplinary order. Click here to verify a license.
6.The station owner, manager and licensed Smog Check technicians or other employees of the station:
•Must not have been convicted of a crime within the preceding three-year period that is substantially related to the duties of a licensed Automotive Repair Dealer, Smog Check station, or Smog Check technician.
•Must not be serving a probationary period as a result of any such criminal proceeding.
•Must not have been found liable in a civil proceeding, excluding small claims matters, within the preceding three-year period, for acts or omissions that are substantially related to the duties of a licensed Automotive Repair Dealer, Smog Check station, or Smog Check technician.
7.The station must not have engaged in any conduct that would be cause for discipline of the station’s Automotive Repair Dealer registration or Smog Check station license.
8.The station must pass a Quality Assurance inspection administered by Bureau representative as part of the certification process. A Quality Assurance inspection consists of the following:
A.A verification of compliance with all licensure and license posting requirements.
B.A verification of compliance with all signage requirements.
C.A verification of compliance with all estimate, repair order, invoice and record keeping requirements.
D.A verification of possession of all required manuals and publications.
E.A verification of possession of all required tools and equipment and a verification of their proper working order.
F.Evaluations of licensed Smog Check technicians’ ability to perform complete Smog Check inspections, diagnoses, and repairs of failed vehicles.
Smog Check stations located in Change of Ownership areas need only meet requirements 4-7, to obtain Gold Shield certification.
GSR-2 (Rev. 07/08)
Form 3523 - Form 3523 is divided into sections for regular credit, alternative incremental credit, and credit carryover computation.
Firearm Permit Ca - A reminder is included that the application fee is non-refundable, emphasizing the importance of accuracy and completeness in the submission.