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In California, the DCA GSR 1 form is a key part of the process for automotive repair stations seeking to attain Gold Shield certification under the Bureau of Automotive Repair's Gold Shield Program. This form is designed to ensure that smog check stations meet specific standards aimed at promoting environmental health and vehicle emissions compliance. Applicants must complete the form accurately, providing details such as the station's name, address, and ownership structure, as well as listing any partners or managers. The GSR 1 form does not require a fee but does impose strict eligibility requirements. These include maintaining a satisfactory Comparative Failure Rate, conducting a minimum number of successful emissions repairs in the previous quarter, and having no serious legal or disciplinary issues related to the station or its personnel. Moreover, stations must pass a Quality Assurance inspection evaluating various operational aspects before certification can be granted. It's important for applicants to understand that their application is only valid for the quarter in which it is submitted, necessitating careful attention to timelines and requirements. Failure to meet any criterion might result in application deficiencies, forcing a reapplication in the following quarter. Overall, the GSR 1 form is a crucial document for those in the automotive repair industry who aim to provide enhanced emissions-related services to the public while adhering to California's stringent environmental regulations.

California Dca Gsr 1 Example

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

YES

NO

 

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

YES

NO

 

Automotive Repair?

 

 

 

4.

Been issued a citation by the Bureau of Automotive Repair within the last year?

YES

NO

 

 

 

GSR-1 (Rev. 12/08)

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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.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

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

YES

NO

 

INITIAL

 

 

 

DATE

 

PASSED ENFORCEMENT RECORD CHECK

YES

NO

 

INITIAL

REAPPLY DATE

 

DATE

 

PASSED QUALITY ASSURANCE INSPECTION

YES

NO

 

INITIAL

 

 

 

DATE

 

 

 

 

 

 

 

 

 

FINAL APPROVAL

YES

NO

 

INITIAL

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GSR-1 (Rev. 12/08)

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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)

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Form Characteristics

Fact Name Fact Description
No Application Fee There is no fee required to submit the GSR-1 application.
Quarterly Validity The application is valid only for the quarter when it is submitted.
Required Services Gold Shield stations must provide specific emissions-related services to the public.
Eligibility Requirements Applicants must meet all qualification criteria to be certified as a Gold Shield station.
Governing Law The GSR-1 form is governed by California Health and Safety Code Section 44050.
Criminal History Disclosure Applicants must disclose any past criminal convictions relevant to automotive repair duties.
Application Submission Completed applications must be mailed to the Bureau of Automotive Repair at the specified address.
Quality Assurance Inspection A Quality Assurance inspection must be passed as part of the certification process.

Guidelines on Utilizing California Dca Gsr 1

Completing the California DCA GSR-1 form is a crucial step for Smog Check stations seeking Gold Shield certification. To ensure a smooth application process, clear instructions are provided below. Follow each step carefully to avoid any delays in your submission.

  1. Obtain the California DCA GSR-1 form, which can be found online or requested from the Bureau of Automotive Repair.
  2. Read all information on the application, including the Gold Shield Qualification Requirements outlined in the GSR-2 document.
  3. Fill in the following details in the form:
    • Station Name
    • Phone Number
    • Street Address
    • City
    • State (CA)
    • ZIP Code
  4. Select the ownership type of the Smog Check station (e.g., Sole Proprietor, Partnership, Corporation, LLC) and provide the name(s) of the owner(s) along with the appropriate license number(s).
  5. Answer all questions regarding criminal convictions, civil liabilities, or disciplinary actions related to the station and its personnel. Provide explanations if you answer "Yes" to any question, using additional paper if necessary.
  6. Sign and date the application. All partners and members of the LLC must sign, indicating their agreement with the statements made in the application.
  7. Review the completed application for accuracy and ensure that all required fields are filled out and signed.
  8. Mail the completed application to the Bureau of Automotive Repair Licensing Unit at the address provided on the form:
    Bureau of Automotive Repair Licensing Unit
    Gold Shield Program
    10240 Systems Parkway
    Sacramento, CA 95827

Once the application has been submitted, you will receive a notification regarding its status. It's essential to meet all requirements, as failure to do so may result in a deficient application, delaying the certification process. Prepare to address any deficiencies promptly in order to reapply if necessary.

What You Should Know About This Form

What is the California DCA GSR 1 form?

The California DCA GSR 1 form is an application that automotive repair stations use to apply for Gold Shield certification. This certification allows stations to perform state-subsidized emissions-related repairs and other important inspections. Completing the form is essential for stations wanting to offer these services.

Is there a fee associated with the GSR 1 form?

No, there is no fee required when submitting the GSR 1 form. This makes it easier for qualified stations to apply for the Gold Shield certification without worrying about additional costs.

What qualifications must a station meet to apply for Gold Shield certification?

To be eligible for Gold Shield certification, a station must meet several requirements. These include maintaining a satisfactory Comparative Failure Rate, completing a certain number of successful emissions repairs in the previous quarter, and not having severe disciplinary actions against current owners or staff. All rules are designed to ensure that only capable stations provide these vital services.

How does a station demonstrate successful emissions repairs?

A station shows successful emissions repairs by documenting that a vehicle failed its emissions test, underwent repairs at that station, and received a Certificate of Compliance within ten days after those repairs. This process must occur within designated timeframes to qualify.

What happens if my application has deficiencies?

If there are deficiencies in your application, you will receive a notice listing the specific issues. Depending on the type of deficiency, you may need to reapply either at the beginning of the next quarter or after a specific period has passed.

What does the Quality Assurance inspection entail?

The Quality Assurance inspection is a verification process that checks several aspects of the station. A Bureau representative will ensure compliance with licensing, signage, record-keeping, and that all required tools and manuals are available. Additionally, they will evaluate the Smog Check technicians' abilities. Passing this inspection is crucial for certification.

Can a station that has had past disciplinary issues apply for Gold Shield certification?

Stations that have had disciplinary actions in the past may face challenges when applying. Specifically, the station's ownership and staff must not have been involved in specific misconduct within the preceding three-year period. Each situation will be reviewed individually when evaluating the application.

Are there different rules for Change of Ownership area stations?

Yes, stations located in Change of Ownership areas follow different rules. They only need to meet certain requirements (4-7) to obtain Gold Shield certification, which simplifies the process for them compared to other stations.

How do I submit the GSR 1 form after completing it?

After completing and signing the GSR 1 form, mail it directly to the Bureau of Automotive Repair Licensing Unit at the provided address. It's important to ensure that all required information is filled out accurately to avoid any delays in processing.

Common mistakes

Applying for the Gold Shield Station Certification can be a critical step for your automotive repair business in California. However, mistakes during the application process can lead to delays or denials. Here are common errors to avoid when completing the California DCA GSR 1 form.

One frequent mistake is failing to read the instructions thoroughly. Ignoring provided guidelines can lead to incomplete applications. Every section of the form must be carefully reviewed. It’s essential to understand the requirements and ensure all necessary information is provided.

Many applicants overlook the signature requirement. Each partner or member of a limited liability company (LLC) must sign the application. An unsigned application is incomplete and will not be processed. Ensure that all signatures are collected before submission to avoid unnecessary hold-ups.

Not providing accurate or complete ownership information is another common error. The ownership type must be clearly indicated, whether it is a sole proprietorship, partnership, corporation, or LLC. Any deviation or lack of clarity could raise questions that delay processing.

Application errors often arise from answering eligibility questions unclearly. For instance, if the answer to a question is "yes," an explanation is needed. Simply leaving this section blank or providing vague answers could be problematic. Be specific and attach additional documentation if necessary. Clarity and completeness are crucial.

Inaccurate contact information is another mistake. The form requires a clear listing of the station name, address, and phone number. Double-check these details to ensure they are correct. Incorrect information can complicate communication and status updates regarding your application.

Some applicants believe that submitting the form digitally or via fax is acceptable. However, it needs to be mailed to the specified address. Adhering to postal submission standards is vital to ensure the application is formally received.

Another oversight involves understanding the timeframe of the application’s validity. The application is only valid for the quarter in which it is filed. If the submission is made at the wrong time, it may result in having to reapply during the next quarter, adding to the overall timeline for certification.

Failing to keep documentation can also be detrimental. Applicants must maintain all supporting documents that verify statements on the application. Should the Bureau request more information or clarification, having ready access to these documents will expedite the process.

Lastly, some applicants do not keep track of deadlines. Each requirement contains specific timeframes for reapplication should deficiencies arise. Knowing these details can keep your certification process on track and prevent delays. Staying organized and attentive to each step will contribute significantly to your success.

Documents used along the form

The California DCA GSR 1 form, used for the Gold Shield Station Certification Application, often requires several additional documents for comprehensive processing and compliance. Below is a list of related forms and documents that are frequently needed in conjunction with the GSR 1 form.

  • Gold Shield Qualification Requirements (GSR-2): This document outlines the standards and criteria that a Smog Check station must meet to achieve Gold Shield certification. It is essential for understanding eligibility and preparation requirements.
  • Smog Check Program License Application: This form is necessary for establishing or renewing a Smog Check station's license. It contains detailed information about the station's personnel and operational guidelines.
  • Repair Order Form: When repairs are made, this document captures the service details and parts used. It is mandatory for compliance and record-keeping purposes under California automotive regulations.
  • Certificate of Compliance: This certificate is issued after a car passes an emissions test following repairs. It serves as proof that the vehicle meets state environmental standards.
  • Inspection Report Form: This form is used to document the findings of vehicle inspections. It must be completed accurately to ensure transparency and regulatory compliance.
  • Citation Appeal Form: If a Smog Check station receives a citation, this form allows them to contest the citation formally. Timely submission is crucial for maintaining operational status.

Gathering these documents along with the California DCA GSR 1 form is critical for ensuring a smooth application process. Being prepared can significantly expedite the certification and operational setup of your Smog Check station.

Similar forms

The California DCA GSR 1 form, which is used for Gold Shield Station Certification, has similarities with several other documents used in professional or regulatory contexts. Here’s a list of six documents that share some characteristics with the GSR 1 form:

  • Business License Application: Like the GSR 1 form, a business license application requires detailed information about the business structure, ownership, and compliance with local regulations to ensure legitimacy before operating.
  • Certification Application Forms: Many industries feature certification application forms that assess qualifications and adherence to predetermined standards, resembling how the GSR 1 form evaluates qualification requirements for the Gold Shield Program.
  • Permit Application Forms: A permit application form often requires the applicant to provide information about equipment, training, and safety measures similar to the GSR 1, where the station’s capabilities and compliance are assessed for emissions testing.
  • Registration Forms for Professional Licenses: These forms gather personal and professional information about the applicant, verifying their fitness to practice within their field, much like the GSR 1 that checks criminal and disciplinary history for eligibility.
  • Health and Safety Compliance Forms: Such forms collect data on operational practices and standards that must be met, comparable to the GSR 1 form’s focus on compliance with emissions repair regulations and station practices.
  • Tax Registration Forms: These require similar basic business information, ownership details, and compliance with governmental regulations, echoing the structure and requirements found in the GSR 1 application process.

Dos and Don'ts

Things to do when filling out the California DCA GSR 1 form:

  • Read all instructions carefully before starting the application.
  • Ensure that all required fields are completed thoroughly.
  • Provide accurate and truthful information, especially regarding past convictions or citations.
  • Sign and date the application where indicated.
  • Double-check the mailing address for accuracy before sending your application.

Things not to do when filling out the California DCA GSR 1 form:

  • Do not leave any required fields blank.
  • Avoid providing false or misleading information, as it can result in application rejection.
  • Do not send the application without your signature and date.
  • Do not delay mailing after completing the form, as it may only be valid for the current quarter.
  • Do not forget to attach any necessary additional documentation when required.

Misconceptions

Here are five misconceptions about the California DCA GSR 1 form, along with clarifications to help clear up any confusion.

  • No application fee is required. Some believe that there will be hidden fees later in the process. However, the application specifically states that there is no fee required when submitting the GSR 1 form.
  • Completing the form guarantees certification. Many think that just submitting the form is enough for Gold Shield certification. In fact, applicants must meet all qualification requirements to pass. Failure to meet even one requirement can delay the certification process.
  • All stations can automatically apply for Gold Shield certification. People often think that any Smog Check station can apply for certification at any time. However, only those that meet specific eligibility criteria—including a required Comparative Failure Rate—can submit the GSR 1 form.
  • Deficiency notices are final. There is a misconception that receiving a deficiency notice means the application is completely rejected. In reality, applicants can address the noted deficiencies and reapply during the next quarter.
  • Past violations disqualify a station forever. Some believe that any historical corrective actions or violations permanently disqualify a Smog Check station. This isn’t true. Depending on the severity and timing of the violations, stations may still be eligible to pursue certification after addressing those issues.

Key takeaways

Filling out and using the California DCA GSR-1 form is essential for Smog Check stations seeking Gold Shield certification. The following key takeaways outline important aspects of this process:

  • No application fee: There is no charge to submit the GSR-1 form.
  • Review requirements: Applicants must carefully read all instructions and qualification requirements outlined in the application.
  • Complete the application: Ensure all sections are filled out accurately and the form is signed by all partners or members of the LLC.
  • One quarter validity: The application is valid only for the quarter in which it is submitted.
  • Mailing address: Completed applications must be sent to the Bureau of Automotive Repair Licensing Unit at the specified address.
  • Services provided: Gold Shield stations must offer state-subsidized emissions-related repairs and certification for gross polluters.
  • Deficiency notice protocol: If the application is deficient, a notice will be issued. Deficiencies must be corrected before reapplying.
  • Reapplication periods: Specific timelines dictate when to resubmit the application based on the deficiencies noted.
  • Truthful certification: Signers of the application must certify that all information provided is true under penalty of perjury.
  • Eligibility requirements: Stations must meet specific performance standards, including comparative failure rates and successful emissions repairs.

Understanding these points can help streamline the application process and ensure compliance with California's Gold Shield certification requirements.