CG-5148A Certificate of Fitness for the Carriage of Dangerous Che

OMB No. 1625-0094

Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk

Issued under the provision of the IMO Code for the Construction and Equipment of Ships Carrying
Dangerous Chemicals in Bulk (resolutions MEPC.20(22) and MSC.9(53)) [BCH Code] under the
authority of the Government of:

THE UNITED STATES OF AMERICA
by the
UNITED STATES COAST GUARD

Particulars of Ship
Name of Ship

Distinctive
Number or Letters

Port of Registry

Gross
Tonnage

Ship Type**
(Code Paragraph
2.2.4)

IMO Number*

Date on which keel was laid or on which the vessel was at a similar stage of construction or , (in the case of a converted
ship) date on which conversion to chemical tanker was commenced: ________________________________________
The ship also complies fully with the following amendments to the Code:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
The ship is exempted from compliance with the following provision of the Code:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
THIS IS TO CERTIFY:

1

That the ship has been surveyed in accordance with the provisions of section 1.6 of the Code;

2

That the survey showed that the construction and equipment of the ship and the condition thereof are in all respects

satisfactory and that the ship:

.1 complies with the relevant provisions of the Code applicable to ships referred to in 1.7.2;

.2 complies with the relevant provisions of the Code applicable to ships referred to in 1.7.3;

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control
number.
The Coast Guard estimates that the average burden for this report is 30 minutes. You may submit any comments concerning the accuracy of this
burden estimate or any suggestions for reducing the burden to: Commandant (CG-CVC), U.S. Coast Guard, 2100 2nd St., SW, Stop 7581
Washington, DC 20593-7581 or Office of Management and Budget, Paperwork Reduction Project (1625-0094), Washington, DC 20503.
* In accordance with the IMO ship identification number scheme. Adopted by the Organization by resolution A.600 (15).
** See note 2 on page 2 of this certificate.

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 1 of ___

3

That the ship has been provided with a manual in accordance with Appendix 4 of MARPOL Annex II as called for by
regulation 14 of Annex, and that the arrangements and equipment of the ship prescribed in the manual are in all
respects satisfactory;

4

That the ship meets the requirements for the carriage in bulk of the following products, provided that all relevant
operational provisions of the Code and MARPOL Annex II are observed:
Product

Conditions of carriage
(tank numbers, etc.)

Pollution Category

Tank numbers referred to in this list are identified on attachment 1, showing a signed and dated tank plan.
Continued on attachment 2, additional signed and dated sheets.*

5

6

That, in accordance with
manner:

, the provisions of the Code are modified in respect of the ship in the following

That the ship must be loaded:
* .1 in accordance with the loading conditions provided in the approved loading manual; stamped and dated

____________________ and signed by a responsible officer of the Administration, or of an organization

recognized by the Administration;

* .2 in accordance with the loading limitations appended to this Certificate.
Where it is required to load the ship other than in accordance with the above instructions, then the necessary
calculations to justify the proposed loading conditions should be communicated to the to the certifying Administration
who may authorize in writing the adoption of the proposed loading condition.**
This certificate is valid until ________________________
of the Code.***
(ddmmmyyyy)

subject to surveys in accordance with 1.6

Issued at __________________________________________ , ______________________
(Place of issue of Certificate)
(Date of issue)
The undersigned declares that he is duly authorized by the said Government to issue this Certificate
_______________________________________
(Signature of official issuing the Certificate)
Notes on completion of Certificate:
1

The Certificate can be issued only to ships entitled to fly the flags of States which are a party of MARPOL 73/78.

2

Ship type: Any entry under this column must relate to all relevant recommendations, e.g. an entry “Type 2” should mean Type 2 in all respects
prescribed by the code. This column would not usually apply in the cases of an existing ship and in such a case should be noted “see paragraph
2.2”.

3

Products: products listed in chapter 17 of the Code, or which have been evaluated by the Administration in accordance with 1.8 of the Code,
should be listed. In respect of the latter “new” products, any special requirements provisionally prescribed shall be noted.

4

Products: The list of products the ship is suitable to carry should include the Noxious Liquid Substances of Category Z which are not covered by
the Code and shall be identified as “chapter 18 category Z”.

5

Conditions of carriage: If a Certificate is issued to a ship which is modified in accordance with the provision of regulation 1(12) of Annex II to
MARPOL 73/78, the Certificate should indicate in the top of the table of products and conditions of carriage the following statement: “This ship is
certified to carry only pollution hazard chemicals”.

__________________________________
*
Delete as appropriate.

** Instead of being incorporated in the Certificate, this text may be appended to the Certificate if duly signed and stamped.

*** Insert the date of expiry as specified by the Administration in accordance with 1.6.6.1 of the Code. The day and the month of this day correspond

to the anniversary date as defined in 1.4.16D of the Code, unless amended in accordance with 1.6.6.8 of the Code.

Reset

U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 2 of ___

Endorsement for Annual and Intermediate Surveys
THIS IS TO CERTIFY that, at a survey required by 1.6.2 of the Code, the ship was found to comply with the relevant
provisions of the Code.

Annual Survey:

Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________
Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________
Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________
Annual Survey:

Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 3 of ___

ANNUAL/INTERMEDIATE SURVEY IN ACCORDANCE

WITH PARAGRAPH 1.6.6.8.3

THIS IS TO CERTIFY that, at an
survey in accordance with paragraph 1.6.6.8.3 of the Code, the ship
was found to comply with the relevant provisions of the Convention:

Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________

ENDORSEMENT TO EXTEND THE CERTIFICATE IF VALID FOR

LESS THAN 5 YEARS WHERE PARAGRAPH 1.6.6.3 APPLIES

The ship complies with the relevant provisions of the Convention, and this Certificate shall, in accordance with
paragraph 1.6.6.3 of the Code, be accepted as valid until: ________________________

Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________
ENDORSEMENT WHERE THE RENEWAL SURVEY HAS BEEN COMPLETED
AND PARAGRAPH 1.6.6.4 APPLIES
The ship complies with the relevant provisions of the Convention, and this Certificate shall, in accordance with
paragraph 1.6.6.4 of the Code, be accepted as valid until: ________________________

Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 4 of ___

ENDORSEMENT TO EXTEND THE VALIDITY OF THE CERTIFICATE UNTIL

REACHING THE PORT OF SURVEY OR FOR A PERIOD OF GRACE WHERE

PARAGRAPH 1.6.6.5 OR 1.6.6.6 APPLIES

This Certificate shall, in accordance with paragraph
__________________

of the Code, be accepted as valid until:

Signed:

_____________________________________
(Signature of duly authorized official)

Place:

_____________________________________
Date:

_____________________________________

ENDORSEMENT FOR ADVANCEMENT OF ANNIVERSARY DATE WHERE
PARAGRAPH 1.6.6.8 APPLIES
In accordance with paragraph 1.6.6.8 of the Code, the new anniversary date is:

__________________

Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________
In accordance with paragraph 1.6.6.8, the new anniversary date is:

__________________

Signed:
_____________________________________
(Signature of duly authorized official)

Place:
_____________________________________
Date:
_____________________________________

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 5 of ___

Attachment 1 to the Certificate of Fitness for the Carriage of Dangerous Chemicals in Bulk
TANK PLAN

Cargo Tanks Above/Below Main Deck

Name of ship: ___________________________

Distinctive number or letters: ________________

BOW

PORT

STARBOARD

STERN

Date: ____________

_____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 6 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 3 & 4 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 7 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 8 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 9 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 10 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk

Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 11 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 12 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 13 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 14 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 15 of ___

Attachment 2 to the International Certificate of Fitness for the Carriage of

Dangerous Chemicals in Bulk
Continued list of products to those specified in section 4, and their conditions of carriage.
Products (refer to Notes 1, 2 on
completion of Certificate)

Date: ___________

Conditions of carriage
(tank numbers, etc.)

Pollution Category

____________________________________
Officer in Charge, Marine Inspection, U.S. Coast Guard

Reset
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5148A, (Rev. 05-12)

Page 16 of ___