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2. Please select the applicable checkbox(es):*

   Check both boxes if this application is for Tug & Barge.

   1. Tug

   1. Barge
4. Tug Name
5. Tug L.O.A.
6. Choose one

   1. Feet & Inches
   2. Meters
8. Last Port
9. Next Port
11. Tug Owner/Operator/Charter/Line
12. Berth Requested
    -- Select One --123567
14. Estimated Arrival Date
    Estimated Arrival Date

    Estimated Arrival Date
15. Estimated Departure Date
    Estimated Departure Date

    Estimated Departure Date
19. Barge Name/Numbers
20. Barge L.O.A.
21. Choose One

    1. Feet & Inches
    2. Meters
22. Type of Barge
    -- Select One --Lash BargeOcean Going BargeRiver Barge
24. Inbound Cargo/Commodity
25. Estimated Amount
26. Cargo Volume
    -- Select One --Short TonsMetric TonsBoard FeetCubic FeetUnit/PiecesGallonsBarrels
28. Outbound Cargo/Commodity
29. Estimated Amount
30. Cargo Volume
    -- Select One --Short TonsMetric TonsBoard FeetCubic FeetUnit/PiecesGallonsBarrels
32. Choose below, as applicable

    1. MOB/DEMOB

    1. Fresh Water

    1. Crew Change

    1. Hot Work
34. Stevedore?

    1. Yes
    2. No
35. Stevedore Company
37. Special Dockage

    1. Layberth
    2. Display
    3. Repair
38. If Repairs, Party Performing Repairs
40. Security Compliance
    In accordance with USCG 33 CFR 105.270(b)(2), advance notice of vessel stores/bunkers is required.
42. Stores?

    1. Yes
    2. No
43. Company
45. Bunkers

    1. Yes
    2. No
46. 1. Landside
    2. Waterside
47. Date
    Date
49. Company
50. Barge ID
52. Waste Disposal/Dumpster

    1. Yes
    2. No
53. Company
55. MARSEC 2 or 3
    If alert level is at MARSEC 2 or 3, a DOS will be exchanged by the Vessel Security Officer (VSO) with the Port Facility Security Officer (FSO), or designee when the vessel actually arrives.
57. VSO Name*
58. VSO Phone Number*
62. BILLING
64. Date of Application*
    Date of Application
66. Vessel Agent Company*
67. Vessel Agent Phone Number*
69. Vessel Agent Company Billing Address*
71. Name of Representative Submitting Application*
72. Name of Agent Assigned to the Vessel*
74. Contact Email*
76. THE UNDERSIGNED COMPANY, AGENTS, FOR THE ABOVE NAMED VESSEL/TUG/BARGE(s), IN CONSIDERATION FOR APPROVAL OF THE BERTH APPLICATION, AGREES TO BE BOUND AND REPRESENTS THAT ALL “USERS” AS DEFINED IN THE PORT OF PENSACOLA TARIFF, FOR WHICH IT HOLDS ITSELF OUT AS AGENTS OR ACTS AS AGENTS, AGREE TO BE BOUND BY ALL RULES, REGULATIONS, TERMS, CONDITIONS AND CHARGES AS PUBLISHED IN THE PORT OF PENSACOLA TARIFF, INCLUDING ACCEPTANCE OF FINANCIAL RESPONSIBILITY THEREFOR. HAZARDOUS MATERIALS ACCEPTED ONLY WITH PRIOR PORT MANAGEMENT APPROVAL, AND ONLY IF IN COMPLIANCE WITH APPLICABLE GOVERNMENTAL REGULATIONS. CHAPTER 376.071. FLORIDA STATUTE PROVIDES THAT ANY VESSEL OPERATING IN STATE WATERS WITH A STORAGE CAPACITY TO CARRY 10,000 GALLONS OR MORE OF POLLUTANTS AS FUEL AND CARGO SHALL MAINTAIN AN ADEQUATE WRITTEN SHIP-SPECIFIC SPILL PREVENTION AND CONTROL CONTINGENCY PLAN. VIOLATORS ARE SUBJECT TO FINE AS ADMINISTERED BY THE STATE OF FLORIDA.
78. Accept Terms and Conditions*

    1. Accept

    1. Decline
79. Port Info
    PORT SECURITY PHONE #: 850-436-5075 GATE HOURS: 24/7 MARINE RADIO CHANNEL: 16
83. - - - - - - - - - - - - - - - - Please Leave Blank - Port Will Complete - - - - - - - - - - - - - - - -
85. Berth Assigned
86. Approved Date
87. Signature of Port Member
89. Reassigned Date
90. Reassigned Berth #
91. MARSEC Level at Time of Filing
93. All records, forms and communications submitted to the City of Pensacola pertaining to official business will be subject to disclosure under the Florida Public Records Law, unless they are defined by the law as exempt or confidential.
Leave This Blank:


95. 1. Receive an email copy of this form.
96. Email address

    This field is not part of the form submission.

97. Submit Submit and Print

* indicates a required field