Special AmendmentPlease right-click and select "Save link as"

This permit is not valid in combination with any other permit issued under Section 110

ORIGINAL / ORIGINALE Disponible en franais Page 1 of 4SR-E-503E (2017/01) Queen's Printer for Ontario, 2017

Special Amendment /Modification spciale

Issued under Section 110 of the Highway Traffic Act. Subject to conditions listed throughout all 3 Page(s) of this amendment.Dlivr en vertu de l'article 110 du Code de la route. Sous rserve des conditions dcrites tout au long de la modification de 3 page(s).

Issued To Dlivr All holders of existing Annual Permits

CVOR No.N dIUVU

Permit No.No du permis Issued by:mis par :Time:Heure :Date:Amendment FeeDroits acquitter pour la modification Per attached schedule

Special Amendment 2016-2020This amendment is issued to temporarily alter the limits and restrictions on Annual Permits. It is applicable to all existing Annual Permits that authorize the movement of indivisible loads on trailers or being towed. The ORIGINAL annual permit, a copy of the amendment, the carrier application to enact the privileges and fax confirmation must be carried in the vehicle and produced upon demand of a police officer or an officer appointed for carrying out the provisions of the Highway Traffic Act.

By appropriately indicating on the attached application and payment to MTO at the single trip permit fees prescribed in Regulation 381/98, one or both of the following privileges may be enacted:

1. Overall Authorized Length for the Vehicle and Load is hereby revised to 32 metres (with the exception of mobile homes where maximum overall length is to be 29.25m) providing the overhang of the load past the centre of the rearmost axle does not exceed 4.65 metres.

2. Notwithstanding any weight restrictions indicated elsewhere on the permit, the authorized weights (except for flatbed trailers) may be expanded to include the following weights for the various configurations as illustrated below. The appropriate Vehicle Configuration Number must be indicated in the application form.

Vehicle Configuration Maximum Allowable Weight

1, 66,000 kg

2. 71,000 kg

3. 66,000 kg

4. 71,000 kg

5. 74,000 kg

6. 78,000 kg

Notes

No axle to exceed 10,000 kg.

Weight on tridum or 3 axle groups may not exceed 30,000 kgs.

Weight on 4 axle groups may not exceed 35,000 kgs.

Weight privileges are not applicable for travel over any posted or modular (Bailey) bridges.

Notwithstanding Condition 7 on the face of the original permit, the permit holder is entitled to overweight privileges indicated when a reduced load period is in effect.

Overweight privileges are prohibited on all highways designated as being subject to reduced loading and posted as such in accordance with Ontario Regulation 615.


ORIGINAL / ORIGINALE Page 2 of 4SR-E-503E (2017/01)

Permit No.: N du permis :

Issued By / mis par Time:Heure :Date:

Issued under Section 110 of the Highway Traffic Act. Emis selon l'article 110 du Code de la route.

1. The carrier must complete and submit to MTO the Application to Exercise Special Amendment Privileges on Ontario Annual Permit. Carriers must fax the above application to MTO at 905 704-2564. No other applications or submissions are to be forwarded to this fax number.

2. Carriers are entirely responsible for clearance verification of the routes to be travelled, as stipulated on all annual permits and remain responsible for any and all damage incurred while operating under the privileges of this permit.

3. This amendment is NOT VALID: a. If driver is unable to produce:

i. The Operators ORIGINAL annual permit, ii. A copy of Part 1 of the Application to Exercise Special Amendment Privileges, iii. A copy of Special Amendment 2016-2020. iv. Confirmation that the application has been successfully faxed to MTO at 905 704-2564,

b. The application or credit card information is missing or incomplete; calculated fees are incorrect; or the fees are not available on the selected credit card,

c. The dates indicated on the application are invalid or exceed the maximum permitted travel days. 4. Validity of the amended privileges may be confirmed by a police officer or an officer appointed for carrying

out the provisions of the Highway Traffic Act by contacting the O/O permit issuing office at 416 246-7166 (dept./ext 6306).

5. This amendment may be used until December 31st , 2020, unless extended by the Ministry of Transportation.

6. This amendment, as well as any carriers continued eligibility to utilize the privileges contained herein, may be terminated at the discretion of the Registrar of Motor Vehicles for breach of any condition of this amendment.

7. The Ministry reserves the right to cancel continued use of this amendment upon thirty (30) days notice at any time.

All other terms and conditions of the original permit remain in effect unless specifically altered by the above listed amendment(s) and/or by any previous amendments. This Amendment may be freely copied, and distributed to all holders of Annual Permits in Ontario.






Application to Exercise Special Amendment Privileges on Ontario Annual PermitPart 1 - Special Amendment 2016-2020Carrier Name

Carrier AddressUnit/Suit/Apt. Street Number Street Name P.O. Box

City/Town/Village Province/State Country Postal/Zip Code

Safety Rating PRIO Account Number

CVOR / NSC No. Annual Permit Number Telephone Number Fax Number

Contact Name - Last Name First Name

Service Provider (if applicable) Contact Name (Last Name, First Name) PRIO Account Number Telephone Number

Transport Tow

Item being transported or towed (authorized by permit)

DestinationOrigin

Route

Travel Dates - Maximum 7 daysFrom YYYY MM DD To YYYY MM DD

Total permit fee is either additional length fee or the distance fee, whichever is greater. Privileges enacted (please check required privileges): Length 32m ($65.00 if enacting length only privileges)

Weight Configuration 1 2 3 4 5 6

Distance






Part 2 - Credit Card Authorization

I, hereby authorize the Ministry of Transportation to charge my

(check one only): Visa MasterCard

Card Number Expiry Date (mm/yy) Amount ($)

Date (yyyy/mm/dd)Authorized SignatureName

AmendmentApplication to Exercise Special Amendment Privileges on Ontario Annual Permit

This permit is not valid in combination with any other permit issued under Section 110ORIGINAL / ORIGINALEDisponible en franaisPage ofSR-E-503E (2017/01) Queen's Printer for Ontario, 2017 ..\..\..\Ontario logo\NEW Ont Trillium logo blk.bmpGovernment of OntarioPermit No.: N du permis :Issued By Issued By / mis par Time:Heure :Issued under Section 110 of theHighway Traffic Act. Emis selon l'article 110 duCode de la route.This permit is not valid in combination with any other permit issued under Section 110ORIGINAL/ ORIGINALEPage ofSR-E-503E (2017/01) Amendment0,0,0normalrunScriptxfa.form.form1.variables.oUtility.goBookMark(xfa.form.form1.page1.header.amend.amendment.formHeader.FormTitle.somExpression)Special Amendment/Modification spcialeIssued under Section 110 of theHighway Traffic Act.Subject to conditions listed throughout all3 Page(s) of this amendment.Dlivr en vertu de l'article 110 du Code de la route.Sous rserve des conditions dcrites tout au long de la modification de3 page(s).Barcode imageIssued ToDlivr CVOR No.N dIUVU..\..\..\Ontario logo\NEW Ont Trillium logo blk.bmpGovernment of OntarioPermit No.Nodu permisIssued by:mis par :Time:Heure :Amendment FeeDroits acquitterpour la modificationPer attached scheduleSpecial Amendment 2016-2020This amendment is issued to temporarily alter the limits and restrictions on Annual Permits.It is applicable to all existing Annual Permits that authorize the movement of indivisible loads on trailers or being towed.The ORIGINAL annual permit, a copy of the amendment, the carrier application to enact the privileges and fax confirmationmust be carried in the vehicle and produced upon demand of a police officer or an officer appointed for carrying out the provisions of the Highway Traffic Act.By appropriately indicating on the attached application and payment to MTO at the single trip permit fees prescribed inRegulation 381/98, one or both of the following privileges may be enacted:1. Overall Authorized Length for the Vehicle and Load is hereby revised to 32 metres (with the exception of mobile homes where maximum overall length is to be 29.25m) providing the overhang of the load past the centre of the rearmost axle does not exceed 4.65 metres.2. Notwithstanding any weight restrictions indicated elsewhere on the permit, the authorized weights (except for flatbed trailers) may be expanded to include the following weights for the various configurations as illustrated below. The appropriate Vehicle Configuration Number must be indicated in the application form.Vehicle ConfigurationMaximum Allowable Weight1,.\vehicle-1.jpgVehicle Configuration 1. Four axle commercial motor vehicle and three axle float type trailer66,000 kg2..\vehicle-2.jpgVehicle Configuration 2. Four axle commercial motor vehicle and four axle float type trailer71,000 kg3..\vehicle-3.jpgVehicle Configuration 3. Three axle commercial motor vehicle, single axle jeep dolly and three axle float type trailer66,000 kg4..\vehicle-4.jpgVehicle Configuration 4. Three axle commercial motor vehicle, single axle jeep dolly and four axle float type trailer71,000 kg5..\vehicle-5.jpgVehicle Configuration 5. Three axle commercial motor vehicle, two axle jeep dolly and three axle float type trailer74,000 kg6.C:\Users\Phung\Desktop\working\MTO\dec24\SR-L-105A\SRL105\images\vehicle-7.jpgVehicle Configuration 6. Three axle commercial motor vehicle, two axle jeep dolly and four axle float type trailer78,000 kgNotes No axle to exceed 10,000 kg. Weight on tridum or 3 axle groups may not exceed 30,000 kgs. Weight on 4 axle groups may not exceed 35,000 kgs. Weight privileges are not applicable for travel over any posted or modular (Bailey) bridges. Notwithstanding Condition 7 on the face of the original permit, the permit holder is entitled to overweight privileges indicated when a reduced load period is in effect. Overweight privileges are prohibited on all highways designated as being subject to reduced loading and posted as such in accordance with Ontario Regulation 615.1. The carrier must complete and submit to MTO the Application to Exercise Special Amendment Privileges on Ontario Annual Permit. Carriers must fax the above application to MTO at 905 704-2564. No other applications or submissions are to be forwarded to this fax number.2. Carriers are entirely responsible for clearance verification of the routes to be travelled, as stipulated on all annual permits and remain responsible for any and all damage incurred while operating under the privileges of this permit.3. This amendment isNOT VALID: a. If driver is unable to produce:i. The OperatorsORIGINAL annual permit,ii. A copy ofPart 1 of the Application to Exercise Special Amendment Privileges,iii. A copy of Special Amendment 2016-2020.iv. Confirmation that the application has been successfully faxed to MTO at 905 704-2564,b. The application or credit card information is missing or incomplete; calculated fees are incorrect; or the fees are not available on the selected credit card,c. The dates indicated on the application are invalid or exceed the maximum permitted travel days.4. Validity of the amended privileges maybe confirmed by a police officer or an officer appointed for carrying out the provisions of theHighway Traffic Act by contacting the O/O permit issuing office at 416 246-7166 (dept./ext 6306).5. This amendment may be used until December 31st, 2020, unless extended by the Ministry of Transportation.6. This amendment, as well as any carriers continued eligibility to utilize the privileges contained herein, may be terminated at the discretion of the Registrar of Motor Vehicles for breach of any condition of this amendment.7. The Ministry reserves the right to cancel continued use of this amendment upon thirty (30) days notice at any time.All other terms and conditions of the original permit remain in effect unless specifically altered by the above listed amendment(s) and/or by any previous amendments. This Amendment may be freely copied, and distributed to all holders of Annual Permits in Ontario.Application to Exercise Special Amendment Privileges on Ontario Annual Permit0,0,0normalrunScriptxfa.form.form1.variables.oUtility.goBookMark(xfa.form.form1.page3.header.FormTitle.somExpression)Application to Exercise Special Amendment Privileges on Ontario Annual PermitPart 1 - Special Amendment 2016-2020Carrier AddressTravel Dates - Maximum 7 daysFromToTotal permit fee iseither additional length fee or the distance fee, whichever is greater.Privileges enacted (please check required privileges): LengthWeight ConfigurationPart 2 - Permit Information. Check required privileges to be enacted: (b) Weight Configuration:Part 1 - Special Amendment 2016-2020. Privileges enacted (please check required privileges): Weight Configuration.DistancePrivileges enacted (please check required privileges): Distance:Part 3 - Permit Information. Check required privileges to be enacted: (c) Distance: Single Trip Permit fee prescribed under O.Reg. 391/98 and subject to change. 29.25 metres for mobile home and modular buildingsDeclarationI/we understand that under the provision of subsection 5 of Section 110 of theHighway Traffic Act, the owner, operator or mover of a heavy vehicle, load, object or structure who has obtained a permit and amendment is nevertheless responsible for all damage that may be caused to the highway, encroachments or railway right of way by reason of the driving, operating or moving of any such heavy vehicle, load, object or structure.Payment MethodPart 2 - Credit Card Authorization hereby authorize the Ministry of Transportation to charge my(check one only):8.0.1291.1.339988.308172Ministry of TransportationSpecial AmendmentSpecial AmendmentCurrentPageNumber: NumberofPages: Permit Number: Issued By : Office 61Time: Date: Print: Reset: TextField1: Vehicle Operator's Registration number : Issued by:: Office 61Amendment Fee: Part 1 - Special Amendment 2016-2020. Carrier Name: Part 1 - Special Amendment 2016-2020. Carrier Address. Unit or Suite, Apartment: Part 1 - Special Amendment 2016-2020. Carrier Address. Street Number: Part 1 - Special Amendment 2016-2020. Carrier Address. Street Name: Part 1 - Special Amendment 2016-2020. Carrier Address. Post Office Box: Part 1 - Special Amendment 2016-2020. Carrier Address. City or Town or Village: Part 1 - Special Amendment 2016-2020. Service Provider Contact Name (Last, First Name): Part 1 - Special Amendment 2016-2020. Service Provider PRIO Account Number: Part 1 - Special Amendment 2016-2020. Carrier Address. Postal/Zip Code: Part 1 - Special Amendment 2016-2020. Safety Rating:: Part 1 - Special Amendment 2016-2020. PRIO Account Number: Part 1 - Special Amendment 2016-2020. Annual Permit Number: Part 1 - Special Amendment 2016-2020. Telephone Number.: Part 1 - Special Amendment 2016-2020. Fax Number.: Part 1 - Special Amendment 2016-2020. Contact Name - Last Name: Part 1 - Special Amendment 2016-2020. Contact Name - First Name: Part 1 - Special Amendment 2016-2020. Service Provider (if applicable) : Part 1 - Special Amendment 2016-2020. Transport: Part 1 - Special Amendment 2016-2020. Tow: Part 1 - Special Amendment 2016-2020. Item being transported or towed (authorized by permit): Part 1 - Special Amendment 2016-2020. Destination: Part 1 - Special Amendment 2016-2020. Origin: Part 1 - Special Amendment 2016-2020. Route Details: Part 1 - Special Amendment 2016-2020. Travel Dates. From, year, 4 digits: Part 1 - Special Amendment 2016-2020. Travel Dates. From, month, 2 digits: Part 1 - Special Amendment 2016-2020. Travel Dates. From, day 2 digits: Part 1 - Special Amendment 2016-2020. Travel Dates. To, year, 4 digits: Part 1 - Special Amendment 2016-2020. Travel Dates. To, month, 2 digits: Part 1 - Special Amendment 2016-2020. Travel Dates. To, day 2 digits: Part 1 - Special Amendment 2016- 2020. Privileges enacted (please check required privileges): length: 32m( 29.25 metres for mobile home and modular buildings) ($65.00 if enacting length only privileges ( Single Trip Permit fee prescribed under O.Reg. 391/98 and subject to change.)): 0weight1: weight2: weight3: weight4: weight5: weight6: Part 1 - Special Amendment 2016-2020. Privileges enacted (please check required privileges): Distance: >500 km ($260.00): Part 2 - Credit Card Authorization. Date. Enter date in format: year: 4 digits, month: 2 digits, day: 2 digits. Or select date from the drop down calendar.: Part 2 - Credit Card Authorization. Authorized Signature: Part 2 - Credit Card Authorization. Name.: Payment Method. Pre-paid PRIO account Number: Payment Method. Credit Card (see page 4): Part 2 - Credit Card Authorization. I, (enter name): Part 2 - Credit Card Authorization. I authorize the Ministry of Transportation to charge my: Visa: Part 2 - Credit Card Authorization. I authorize the Ministry of Transportation to charge my: MasterCard: Part 2 - Credit Card Authorization. Card Number: Part 2 - Credit Card Authorization. Expiry Date (month: 2 digits, year 2 digits): Part 2 - Credit Card Authorization. in the amount of $:

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Special AmendmentPlease right-click and select "Save link as"