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The California DCA GSR 1 form is an essential document for Smog Check stations seeking Gold Shield certification under the Bureau of Automotive Repair's Gold Shield Program. This application is designed to streamline the certification process while ensuring that participating stations meet specific performance and regulatory standards. Notably, there is no fee required to submit the GSR 1 form, making it accessible for eligible stations. Applicants must thoroughly review the Gold Shield Qualification Requirements outlined in the accompanying GSR-2 form. Completing the application involves providing details about the station, including its name, ownership type, and contact information. Additionally, the form requires applicants to disclose any criminal convictions or civil liabilities that may affect their eligibility. Once completed and signed, the application must be mailed to the Bureau's Sacramento office. Importantly, the application is only valid for the quarter in which it is submitted, emphasizing the need for timely and accurate submissions. Gold Shield stations are expected to offer a range of services, such as state-subsidized emissions-related repairs and vehicle certifications, thus playing a vital role in California's efforts to improve air quality.

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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 Specifications

Fact Name Description Governing Law(s)
No Application Fee No fee is required to submit the Gold Shield Station Certification Application (GSR-1). California Health and Safety Code
Quarterly Validity The application is only valid for the quarter in which it is submitted. California Health and Safety Code
Certification Requirements Stations must meet specific performance criteria to be certified as a Gold Shield station. California Health and Safety Code Section 44050
Quality Assurance Inspection A Quality Assurance inspection is required as part of the certification process. California Health and Safety Code

California Dca Gsr 1: Usage Guidelines

Filling out the California DCA GSR 1 form is a straightforward process, but it requires attention to detail to ensure all information is accurate and complete. Following the steps outlined below will facilitate a smooth submission, allowing the application to be processed efficiently.

  1. Obtain the California DCA GSR 1 form from the Bureau of Automotive Repair website or another official source.
  2. Read all instructions and information provided on the form, including the Gold Shield Qualification Requirements (GSR-2).
  3. Fill in the Station Name, Phone Number, Street Address, City, State, and ZIP Code in the designated fields.
  4. Indicate the Ownership Type of the Smog Check station by selecting one of the options: Sole Proprietor, Partnership, Corporation, or LLC.
  5. Provide the Owner(s) Name(s) and License Number in the appropriate spaces.
  6. Answer the questions regarding any past convictions, civil proceedings, license issues, or citations by marking “YES” or “NO” as applicable. If any answer is “YES,” provide explanations as needed.
  7. Sign the application. All partners and members of an LLC must sign the form.
  8. Include the Title and Date next to each signature.
  9. Mail the completed application to the Bureau of Automotive Repair at the address provided on the form.

After submitting the application, it will be evaluated based on the qualification requirements. Ensure that all necessary documentation is accurate and complete to avoid any deficiencies that could delay the certification process.

Your Questions, Answered

What is the purpose of the California DCA GSR-1 form?

The California DCA GSR-1 form is used to apply for Gold Shield Station certification. This certification allows smog check stations to provide state-subsidized emissions-related repairs and perform inspections on vehicles that are identified as gross polluters. It ensures that the station meets specific eligibility requirements set by the Bureau of Automotive Repair, which helps maintain high standards in emissions repair and inspection services.

What are the eligibility requirements for Gold Shield certification?

To qualify for Gold Shield certification, a smog check station must meet several criteria. These include having a Comparative Failure Rate that meets or exceeds the industry average, conducting a minimum of 10 successful emissions repairs in the preceding quarter, and having a repair performance rating in the top 75% of test-and-repair stations. Additionally, the station must not have any citations or disciplinary actions against it or its staff within specified time frames. Passing a Quality Assurance inspection is also mandatory.

Is there a fee to submit the GSR-1 form?

No, there is no fee required to submit the GSR-1 application. However, applicants should ensure they complete the form accurately and provide all necessary information. Incomplete applications may result in a notice listing deficiencies, which could delay certification.

What happens if my application is deficient?

If your application has deficiencies, you will receive a notice detailing the specific issues. You must address these deficiencies before reapplying. The timing for reapplication depends on the nature of the deficiencies. For instance, if the deficiencies relate to criminal convictions or citations, you may need to wait for a specified period before reapplying. It's important to correct the issues and reapply at the beginning of the next quarter for a timely review.

Common mistakes

  1. Incomplete Information: Many applicants forget to fill in all required fields, such as the station name or ownership type. Leaving sections blank can lead to delays.

  2. Missing Signatures: All partners or LLC members must sign the application. Failing to obtain every necessary signature can result in a rejected application.

  3. Incorrect Ownership Type: Choosing the wrong ownership type can cause confusion. It’s crucial to select whether the station is a sole proprietorship, partnership, corporation, or LLC accurately.

  4. Ignoring Qualification Requirements: Some applicants do not read the Gold Shield Qualification Requirements. Not understanding these can lead to submitting an application that does not meet the necessary criteria.

  5. Failure to Attach Explanations: If any questions are answered “YES,” an explanation is required. Omitting this can lead to a deficiency notice.

  6. Incorrect Mailing Address: Sending the application to the wrong address can delay processing. Always double-check the address provided in the instructions.

  7. Not Keeping a Copy: Some applicants forget to keep a copy of the submitted application. This can be problematic if there are questions or issues later on.

  8. Missing Deadline: The application is only valid for the quarter in which it is submitted. Late submissions can result in having to reapply.

  9. Overlooking Deficiency Notices: If a deficiency notice is received, it must be addressed promptly. Ignoring it can lead to further complications in the certification process.

Documents used along the form

The California DCA GSR 1 form is essential for those seeking Gold Shield certification for Smog Check stations. Alongside this form, several other documents may be required to ensure compliance with state regulations and to facilitate the certification process. Below is a list of related forms and documents that are often used in conjunction with the GSR 1 form.

  • GSR-2 Form: This document outlines the qualification requirements for the Gold Shield Program. It details the specific criteria that a Smog Check station must meet to be eligible for certification.
  • Application for Automotive Repair Dealer License: This application is necessary for establishing a legal automotive repair business in California. It includes background information about the business and its owners.
  • Quality Assurance Inspection Report: This report documents the results of the Quality Assurance inspection conducted by a Bureau representative. It verifies compliance with various operational standards required for certification.
  • Citation History Report: This document provides a record of any citations issued to the station or its employees. It is crucial for assessing eligibility based on past violations.
  • Vehicle Information Database (VID) Access Request: Stations must have access to the VID to enter repair data. This request form is used to obtain the necessary permissions to access the database.
  • Employee License Verification: A verification form that confirms the licensing status of Smog Check technicians and other employees. It ensures that all personnel meet the legal requirements to perform their duties.
  • Business Entity Registration Documents: These documents include the registration papers for the business entity (such as LLC or Corporation) and must be submitted to verify the legal status of the business.
  • Insurance Certificates: Proof of liability insurance is often required to protect against potential claims arising from the services provided by the Smog Check station.
  • Repair Order and Invoice Templates: These templates must comply with state regulations for record-keeping. They are essential for documenting repairs and services performed at the station.
  • Staff Training Records: Documentation of training and certifications for staff members is often required. This ensures that all employees are properly trained in emissions testing and repair procedures.

Each of these documents plays a vital role in the certification process for Gold Shield stations. Proper completion and submission of these forms can help ensure compliance with California's automotive regulations, ultimately benefiting both the business and the environment.

Similar forms

The California DCA GSR 1 form is essential for automotive repair stations seeking Gold Shield certification. Several other documents serve similar purposes in various contexts. Here’s a list of seven documents that share similarities with the GSR 1 form:

  • Business License Application: Like the GSR 1 form, this document requires detailed information about the business and its owners. It ensures that the business meets local regulations before operating.
  • Professional License Application: This form is necessary for individuals seeking to practice in regulated professions. It collects personal and professional information, similar to how the GSR 1 gathers details about station owners and technicians.
  • Permit Application for Environmental Compliance: Just as the GSR 1 addresses emissions-related services, this application ensures that businesses comply with environmental regulations, focusing on pollution control and sustainability.
  • State Certification Application for Contractors: This document requires contractors to demonstrate their qualifications and compliance with state laws. It parallels the GSR 1 in verifying the applicant’s ability to meet specific standards.
  • Health Department Permit Application: Similar to the GSR 1, this form is used by businesses in the food industry to ensure compliance with health regulations. It collects information about the business and its practices to protect public health.
  • Occupational Safety and Health Administration (OSHA) Compliance Form: This form is necessary for businesses to demonstrate adherence to workplace safety regulations. It shares a similar purpose of ensuring compliance with industry standards.
  • Insurance Application for Business Liability: Like the GSR 1, this document requires businesses to disclose information about their operations and ownership. It helps ensure that businesses are adequately insured against potential liabilities.

Dos and Don'ts

When filling out the California DCA GSR-1 form, it's important to approach the task with care. Here are four things you should and shouldn't do:

  • Do read all instructions carefully. Understanding the requirements will help ensure your application is complete.
  • Do provide accurate information. Double-check all entries for accuracy to avoid any delays or issues.
  • Do sign the application. Ensure that all required signatures are included, as this is a critical step in the process.
  • Do mail the application promptly. Send it to the specified address to meet the application deadlines.
  • Don't leave any questions unanswered. If a question does not apply, indicate that clearly instead of skipping it.
  • Don't forget to attach additional documents. If explanations are required, provide them as instructed.
  • Don't assume your application is valid indefinitely. Remember, the application is only valid for the quarter in which you apply.
  • Don't ignore the eligibility requirements. Ensure you meet all criteria before submission to avoid a deficient application.

Misconceptions

  • Misconception 1: There is a fee associated with the GSR-1 form application.
  • Many believe that submitting the GSR-1 form requires a fee. In fact, there is no fee required with this application.

  • Misconception 2: The application can be submitted at any time.
  • Some think they can submit the application whenever they want. However, this application is only valid for the quarter in which it is submitted.

  • Misconception 3: All requirements can be met at any time.
  • It is a common misunderstanding that all requirements can be addressed after submission. Failure to meet any requirement will result in a deficient application, and you will need to reapply at the beginning of the next quarter.

  • Misconception 4: Past citations do not affect eligibility.
  • Some applicants believe that prior citations do not impact their ability to apply. This is incorrect. If you have received a citation within the last year, you must reapply after one year from the citation date.

  • Misconception 5: The Quality Assurance inspection is optional.
  • Many think the Quality Assurance inspection is not necessary for certification. This is false; passing this inspection is a crucial part of the certification process.

  • Misconception 6: All partners need not sign the application.
  • Some applicants assume that only one signature is sufficient. In reality, all partners and members of an LLC must sign the application for it to be valid.

Key takeaways

When filling out and using the California DCA GSR 1 form for Gold Shield Station Certification, consider the following key takeaways:

  • No application fee: There is no cost associated with submitting this application.
  • Read carefully: Make sure to read all instructions and the Gold Shield Qualification Requirements (GSR-2) before proceeding.
  • Complete all sections: Fill out the entire application and ensure you sign it before submission.
  • Mail the application: Send your completed application to the Bureau of Automotive Repair at the address provided.
  • Quarterly validity: Remember that the application is only valid for the quarter in which it is submitted.
  • Pass all requirements: You must meet all qualification criteria to be certified as a Gold Shield station. Any deficiencies will result in a notice.
  • Reapply if necessary: If you receive a deficiency notice, follow the guidelines for reapplication based on the specific requirements you did not meet.