Combined Transport Inc. Contacts: Mailing Address: Physical Address: Tax ID: MC SCAC: CMBD
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1 Combined Transport Inc. Physical Address: Mailing Address: Tax ID: MC SCAC: CMBD Bank: Wells Fargo Bank 99 E Broadway Eugene, OR Contact: Yvonne Philibert (541) Contacts: Accounting: Marji Peterson Financial Manager (541) ext.6533 marjip@combinedtransport.com Accounts Payable (541) Sales Managers: Scott Waggoner (541) ext.6566 scottw@combinedtransport.com Michael Paradis (541) ext.6575 michaelp@combinedtransport.com Credit References: M.D. Mullins Heavy Haul PO Box 333 CRST Flatbed Inc Hemlock Avenue Fontana, CA Contact: Ruth or Al System Transport, Inc. PO Box 3456 Spokane, WA (509) Noble & Pitts PO Box Birmingham, AL (256)
2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER McGriff, Seibels & Williams of Oregon 1800 SW First Avenue, Suite 400 Portland, OR INSURED Combined Transport, Inc. Blackwell Consolidation, LLC 5656 Crater Lake Highway P.O. Box 3667 Central Point, OR INSURER F : COVERAGES CERTIFICATE NUMBER: 5WVB6M7V REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A D C B X X COMMERCIAL GENERAL LIABILITY OTHER: CLAIMS-MADE AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAB X X CERTIFICATE OF LIABILITY INSURANCE OCCUR SCHEDULED AUTOS NON-OWNED AUTOS OCCUR CLAIMS-MADE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below CARGO LEGAL LIABILITY Y R943-TCT-15 EX-0710R943-TCT-15 RWE (XS) RWD (CA, IL & TX) MTC INSURER A : The Travelers Indemnity Company of Connecticut INSURER B : Zurich American Insurance Company INSURER C : XL Specialty Insurance Company INSURER D : Travelers Property Casualty Company of America 06/01/ /01/ /01/ /01/ /01/ /01/ /01/ /01/2016 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) DATE (MM/DD/YYYY) 11/05/2015 CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): ADDRESS: INSURER E : INSURER(S) AFFORDING COVERAGE EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE ,000, ,000 5,000 1,000,000 2,000,000 2,000,000 4,000,000 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY JECT LOC X PER STATUTE OTH- ER E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 Per Conveyance/Disaster 1,000,000 NAIC # CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) Page 1 of ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE PRODUCER American Trucking and Transportation Ins. Co., a Risk Retention Group 111 North Higgins Avenue, Suite 300A Missoula, Montana (406) INSURED Combined Transport, Inc. Cardmoore Trucking Ltd. Partnership P.O. Box Crater Lake Avenue Central Point, Oregon Blackwell Consolidation, LLC P.O. Box Blackwell Road Central Point, OR DATE (MM/DD/YYYY) 06/01/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A: American Trucking and Transportation Insurance Company Risk Retention Group INSURER B: N/A INSURER C: N/A COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) CLAIMS OCCUR MADE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY X ANY AUTO ATTCTI115 06/01/ /31/2016 COMBINED SINGLE LIMIT (Ea accident) 5,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) X TRAILER INTERCHANGE 50,000 LIMIT PER TRAILER PROPERTY DAMAGE (Per accident) NON-TRUCKING LIABILITY GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA AUTO ONLY: ACC AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETARY/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT Other DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL THIRTY (30) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) ACORD CORPORATION 1988
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5 P.O. Box 3667 Central Point, OR (541) (800) Fax (541) CREDIT APPLICATION COMPANY NAME: Federal I.D. #: Sole Proprietor, Partnership, Or Corporation: Attention: President or Owner s Name: Mailing Address: City: State: Zip: Physical Address: City: State: Zip: Phone #: Fax #: Yrs. in Business: # of Locations: # of Employees: If Corporation, Address of Corporate Headquarters: Accounts Payable Contact: Phone Number: Fax Number: Phone Number or Extension: Special Instructions: Bank Name: Bank Address: Bank Account Number: Trade Reference: Trade Reference: Trade Reference: Trade Reference: Dispatcher s Name: Bank Contact: Phone Number: Fax Number: Phone Number: Fax Number: Phone Number: Fax Number: Phone Number: Fax Number: Phone Number: Fax Number: CREDIT AGREEMENT: upon acceptance of this application, I/We agree to the following. In accordance with the I.C.C. regulations, all invoices must be paid within fifteen (15) days of invoice date, unless alternate arrangements have been made and agreed to in writing by all parties. Any account surpassing the agreed upon terms may have their credit privileges suspended until the account is paid in full. A 2% per month finance charge may be applied to all unpaid balances, as stated on each invoice. Combined Transport, Inc. reserves the right to seek pre and post-judgment interest from the date of invoice, at a rate of 24% annually, as well as court cost and attorney fees, if litigation ensues. PLEASE SIGN TO AUTHORIZE US THE RIGHT TO ALL CREDIT INQUIRES: Signature: Date: Please Print Name: Title:
6 P.O. BOX 3667 CENTRAL POINT, OR ACCOUNTI NG DEPARTMENT (541) (800) FAX (541) **** COMBINED TRANSPORT. INC****. WIRE / ACH SET-UP INFORMATION Bank Name: Address: Wells Fargo Bank 99 E. Broadway City, State, & Zip: Eugene, OR Contact Person at Bank: Yvonne Philibert Bank Phone #: Account #: ABA #: SWIFT CODE: WFBIUS6S Please provide Combined Transport s invoice # in the remittance . Remittance AR@combinedtransport.com If you have any questions, or need any additional information, please contact Pam Hurley, at:
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11 April 16, 2015 JON CARD COMBINED TRANSPORT INC PO BOX 3667 CENTRAL POINT, OR CERTIFICATE OF STANDARD CARRIER ALPHA CODE (SCAC) RENEWAL The Standard Carrier Alpha Code of COMBINED TRANSPORT INC PO BOX 3667 CENTRAL POINT, OR MC US DOT CMBD has been renewed for: This Alpha Code will apply only to the company name shown above through June 30, Approximately two months prior to expiration of this SCAC, NMFTA will provide a renewal notice which must be promptly returned together with payment to ensure its continued validity. Should the company name or address change, please notify the National Motor Freight Association, Inc. at the address below. Alpha Codes ending with the letter "U" have been reserved for the identification of freight containers. If your Alpha Code ends with the letter "U", it should be used only for this purpose. A non-u ending Alpha Code should be obtained to satisfy other requirements such as company identification for Customs, Electronic Data Interchange, freight payments, etc. If you participate in the Bureau of Customs and Border Protection (BCBP) automated programs (ACE, AMS,CAFES, FAST, PAPS), your SCAC and related company information has been sent to BCBP electronically and is updated on a nightly basis. If you have encountered a problem using your SCAC with BCBP, or a copy this letter has been requested by BCBP, only then should you forward the requested information ( preferred as a PDF or TIF attachment) to the following address: CBP SCAC Processing Bureau of Customs and Border Protection 7681 Boston Blvd., Beauregard 1st Fl Wing A Springfield, VA AMS.SCAC@DHS.GOV NOTICE: Renewal of the above listed SCAC is unrelated to participation in the National Motor Freight Classification (NMFC). Further, it does not confer membership in the National Motor Freight Traffic Association, Inc. nor allow use of the NMFC inconnection with freight rates. For participation and membership information, please call (703) North Fairfax Street Suite 600 Alexandria, VA ph: fax: web: scac@nmfta.org
12 UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION HAZARDOUS MATERIALS CERTIFICATE OF REGISTRATION FOR REGISTRATION YEAR(S) Registrant: COMBINED TRANSPORT, INC Attn: JON CARD PO BOX 3667 CENTRAL POINT, OR This certifies that the registrant is registered with the U.S. Department of Transportation as required by 49 CFR Part 107, Subpart G. This certificate is issued under the authority of 49 U.S.C It is unlawful to alter or falsify this document. Reg. No: XZ Issued: 06/03/2015 Expires: 06/30/2018 HM Company ID: Record Keeping Requirements for the Registration Program The following must be maintained at the principal place of business for a period of three years from the date of issuance of this Certificate of Registration: (1) A copy of the registration statement filed with PHMSA; and (2) This Certificate of Registration Each person subject to the registration requirement must furnish that person s Certificate of Registration (or a copy) and all other records and information pertaining to the information contained in the registration statement to an authorized representative or special agent of the U. S. Department of Transportation upon request. Each motor carrier (private or for-hire) and each vessel operator subject to the registration requirement must keep a copy of the current Certificate of Registration or another document bearing the registration number identified as the "U.S. DOT Hazmat Reg. No." in each truck and truck tractor or vessel (trailers and semi-trailers not included) used to transport hazardous materials subject to the registration requirement. The Certificate of Registration or document bearing the registration number must be made available, upon request, to enforcement personnel. For information, contact the Hazardous Materials Registration Manager, PHH-52, Pipeline and Hazardous Materials Safety Administration, U.S. Department of Transportation, 1200 New Jersey Avenue, SE, Washington, DC 20590, telephone (202)
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