Form MA-1078 CVSSA Agreement

OMB No. 2133-0547
Expiration Date: 12-31-2017

U.S. Department
of Transportation
Maritime Administration

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a
penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless
that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information
collection is 2133-0547. Public reporting for this collection of information is estimated to be approximately 40 hour per
response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to
this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Maritime
Administration, MAR-390, 1200 New Jersey Avenue, SE, Washington, DC 20590.

MARITIME ADMINISTRATION CERTIFIED CRUISE VESSEL SECURITY AND
SAFETY TRAINING PROVIDER AGREEMENT
I, ____________________________(NAME) AM AUTHORIZED BY AND IN BEHALF OF
___________________________________ (THE CORPORATION) A CORPORATION
ORGANIZED

AND

EXISTING

UNDER

THE

LAWS

OF

THE

STATE

OF

______________________ (HEREINAFTER CALLED THE “CORPORATION”), WITH
OFFICES AT _____________________________, (BUSINESS ADDRESS) IN EVIDENCE OF
WHICH

INCORPORATION

A

CERTIFIED

COPY

OF

THE

ARTICLES

OF

INCORPORATION (OR ASSOCIATION) IS FILED HEREWITH (OR HAS BEEN FILED).
I AM AUTHORIZED BY AND IN BEHALF OF THE CORPORATION TO EXECUTE
AND

DELIVER

THIS

AGREEMENT

AS

A

CONDITION

OF

MARITIME

ADMINISTRATION (MARAD) APPROVAL AND CERTIFICATION:
(I) The Corporation agrees that:
(a) The content of approved training courses will conform to the Model Course CVSSA 11-01
Crime Prevention, Detection, Evidence Preservation and Reporting, or other model courses that
may be approved by MARAD.
(b) A complete administrative record to include the student’s assessment reports, a report of
practical tests administered, and a record of classroom attendance, will be maintained at the
training facility or other location approved by MARAD and will be made available for MARAD
review within 3 business days of notice for at least 5 years from the student’s date of
enrollment.
(c) Training courses will be conducted as approved and certified by MARAD.
(d) All administrative records will be provided electronically to MARAD within 3 business day
of a request for review by MARAD officials.
Form MA-1078 (12-2014)

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(e) It will accommodate MARAD attendance in CVSSA training classes and training facilities
whether unannounced or otherwise.
(f) It will authorize course instructors to answer MARAD inquiries and provide course material
as requested.
(g) The identity of students will undergo verification and be evidenced through one of the forms
of photo identification listed under section (h) below. For E-Learning, equivalent arrangements
for student identity will be established, controlled, provided, and administered at the training
provider’s centralized location.
(h) Acceptable forms of identification are:
(1) Merchant Mariner Document;
(2) National Passport;
(3) Armed Forces Identification Card;
(4) Photo identification cards issued by U.S. Federal, state, or local
government agencies; or
(5) Driver’s license with photo of the driver.
(i) It will maintain, for audit purposes, a copy of the identification of all students who
successfully complete the course.
(j) E-learning student projects and work will be reviewed by an assessor meeting the same
qualification standards as an instructor in a live course.
(k) Instructors or training provider personnel will not assist or coach students in any way during
the evaluation process.
(l) It will issue consecutively numbered certificates to students who successfully complete the
approved course.
(m) Blank course completion certificates will be kept secure at all times.
(1) The paper stock of course completion certificates will contain micro printing,
watermarks and/or other effective measures to help prevent production of fraudulent
certificates.
(2) Course completion certificates will be in a standardized format and contain the
following:
(i) the name of the course as stated in the course certification letter;
(ii) the name of the school or training provider;
(iii) the date the training began and was completed;
(iv) the signatures of the course instructor and director or department head;
and
(v) the student’s full name.

Form MA-1078 (12-2014)

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(II) The Corporation agrees to provide:
(a) The class schedule to MARAD one month before any CVSSA training class enrollment.
(b) Copies of training textbooks upon request from MARAD.
(c) Notice to MARAD of any instructor changes no fewer than 10 days prior to course
commencement.
(d) Notice to MARAD in writing within 30 calendar days of any changes in information
previously provided and relied upon for approval and certification, including but not limited to
Corporation status, the course curriculum, teaching staff, maximum teacher/student ratio, class
size, training facility, or training equipment.
(e) Photographs, diagrams, or plans of the training site upon request.
(f) A description of the equipment that will be used during the course. This includes all
equipment to be used during hands-on training and/or testing, and any simulators or simulation
programs to be used. If a simulator or simulation program is to be used, include technical
specifications and brochures provided by the manufacturer.
(g) A request for renewal of course approval and certification at least 90 days before the
approval and certification expiration date.
(III) The Corporation agrees to:
(a) Schedule audits of its CVSSA Training Program by qualified independent auditors at the
Corporation’s expense, according to the schedule stated in the MARAD training provider
certification policy;
(b) Require the auditor to provide a copy of all audit results and any corrective action plan directly
to MARAD;
(c) Implement expeditiously any corrective action plan provided by the auditor or by MARAD;
(d) Immediately report to MARAD any nonconformity with a certified training program, whether
detected in an audit or otherwise;
(e) Allow MARAD personnel to participate in scheduled audits, and allow MARAD to conduct
unscheduled audits of the Training Program at MARAD expense.
(IV) The Corporation acknowledges, understands, and further agrees that:
(a) MARAD certification is effective for a period of five years from the date of certification, or until
the certification is suspended or revoked.
(b) MARAD may suspend or revoke its certification at any time, without notice and with immediate
effect.

Form MA-1078 (12-2014)

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(c) Upon written notice of suspension or revocation of certification, the Corporation will
immediately cease any display, marketing or other use of MARAD certification.
(d) The corporation may request reconsideration of a disapproval of certification, or the suspension
or revocation of certification, through a written request to the Maritime Administrator discussing in
detail the reasons why relief should be granted.
(e) MARAD approval of an application is at the discretion of the agency. Nothing in this agreement
or in the Agency’s policy requires MARAD to issue a certification.

____________________________________________
Signature of Authorized Official and Title
__________________________
Date

PENALTY FOR FALSE STATEMENT: A fine or imprisonment, or both, are provided for violation
of the proscriptions contained in 18 U.S.C. 1001 (see also 18 U.S.C. 286 and 287).

Form MA-1078 (12-2014)