FAX. Toll Free: Phone: * PO Box 2065 Hamilton, MT * Fax: PAGES: 13 (Including Cover Pages) NOTES:
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1 Toll Free: Phone: * PO Box 2065 Hamilton, MT * Fax: FAX FROM: TO: Dispatch PAGES: 13 (Including Cover Pages) NOTES: Please make sure to sign and fax back pages 10-13, along with your carrier authority, a signed W-9 form and a certificate of insurance. Also make sure to have RJ s Truck Brokerage listed as the certificate holder. Company profile MUST be COMPLETELY filled out or we will be unable to enter your company into our computer system. Please fax to, ASAP! Thanks JR Lanser President
2 Table Of Contents Company Profile.3 References Authority....5 W Bond....7 Carrier Contract...10 Carrier Profile...11 Accounts Receivable..12 Carrier s References
3 The Simple Transportation Solution Po Box 2065 Hamilton, MT Hwy 93 N Victor, MT Phone: (406) Fax: (406) MC# Federal ID# SCAC Code: RJBE Here at RJ's we have a great carrier base of over 400 carriers established in our brokerage department, that are more than willing to help with all your transportation needs. We make sure all carriers are DOT regulated with authority, current insurance, and a signed contract on file before they pick up your load. All of our carriers understand the importance of getting your freight where it needs to be, when it needs to be there. Our carriers dedication to providing fast, courteous, and professional service will put your mind at ease. Contact Information Brokerage Contacts Phone# (406) Ext# 2 Jay Clarke rjstruck@montana.com Manager Mac McKay rjbroker1@montana.com Coverage Area: CO, MT Jeff Doerfler jdoerfler@montana.com Coverage Area: Midwest Amanda Berry aberry@montana.com Coverage Area: Southwest Amber Kirkbride akirkbride@montana.com Coverage Area: Northwest Independent Brokers Amy Connell Ph: (303) aconnell@montana.com Kathryn Franklin Ph: (406) kfranklin@montana.com Larry Ruben Ph: (406) lruben@montana.com Sharon Bartels Ph: (406) sbartels@montana.com Jake Roberts Ph: (406) jroberts@montana.com Accounting Contacts Danielle Lanser Ph: (406) rjsadmin@montana.com Anna Luhrsen Ph: (406) rjsadmin2@montana.com
4 J-Mar Enterprises Contact: Tracy Phone: (701) References Below are a few carriers we do business with!! Godfrey Trucking Inc Contact: Linda Phone: (801) Evergreen Express Contact: Chip Phone: (406) AGM Transport Inc Contact: Lacey Phone: (630) T&T Trucking Contact: Debbie Phone: (406)
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6 9/01/2012
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9 MOTOR CONTRACT CARRIER/BROKER AGREEMENT This AGREEMENT made this day of, 20 by and between authorized MOTOR CONTRACT CARRIER licensed under Permit No. MC herein after referred to as CARRIER. And RJ s and authorized property broker herein after referred to as BROKER under license No. MC B. 1. BROKER agrees to offer for shipment and CARRIER agrees to transport in its own equipment, quantities of fright agreed to by both CARRIER and BROKER. 2. CARRIER shall comply with the financial responsibility, and legal requirements of the appropriate federal and state laws and regulatory agencies through which it is authorized to operate. CARRIER shall maintain primary cargo insurance in an amount equal to the full value of the maximum value of goods to be transported at any one time under this agreement, with a minimum insurance of one hundred-thousand dollars ($100,000.00) required CARRIER shall also maintain primary liability insurance in an amount sufficient to cover all liability risks associated with activities related to this agreement, not to be less than one million dollars ($1,000,000.00). CARRIER shall also maintain worker s compensation coverage for all personnel employed by CARRIER in connection with this agreement. Owner-operators are and exception. CARRIER agrees to give 30 days notice prior to cancellation of insurance policies. 3. BROKER agrees to pay CARRIER agreed amount within 30 Days of receipt of and original clearly signed bill of lading. CARRIER shall be liable to BROKER and/or Shipper for any loss or damages noted on bill of lading. CARRIER must approve any additional charges to BROKER in writing. 4. CARRIER shall be responsibly to comply with all applicably DOT regulations as well as all other federal and state regulations pertaining to the operations of a motor carrier. 5. CARRIER agrees to hold BROKER harmless from indemnify BROKER for any liability including all cost to defend claims. CARRIER also agrees to hold BROKER harmless from and indemnify BROKER for any liability resulting from personal injury or property damage which may occur during the operations of carrier pursuant to this agreement, including all cost to defend claims. 6. CARRIER without the prior written consent of BROKER shall not cause or permit any shipment tendered hereunder to brokered to or transported by any other motor carrier.
10 7. CARRIER agrees to support and protect BROKER S efforts in performance of this agreement be refraining from any direct contact or solicitation os BROKER S CUSTOMERS. During the tern of the agreement an for a period of two (2) years from the time of last freight contracted CARRIER shall not directly or indirectly solicit or do business of transportation or warehousing nature with any of BROKER S customers who are services by CARRIER as a result of this agreement unless otherwise agreed to in writing and signed by corporation officer. CARRIER will be responsible to pay twenty-five (25) percent of gross revenue to BROKER if terms of this agreement are violated. 8. The relationship of CARRIER to BROKER shall, at all times be that of an independent contractor except that BROKER shall be the agent for the CARRIER for the collection and payment of services rendered under this contract. 9. This contract is made pursuant to 49 U.S.C , whi h authorizes CARRIER to enter into contracts with purchasers of motor carrier services set forth in this Contract. This Contract is drawn up pursuant to 49 CFR 1053 inclusive. This Contract does not alter the rights and obligations of the parties regarding the transportation subject to this Contract under Title 49 U.S.C. the Bill of Lading Act and common law except as provided herein. IN WITNESS WHEREOF, the parties have executed this Contract at the date and place first set forth above. Broker: RJ s Truck Brokerage Carrier: PO Box 2065 Address: Hamilton, MT City, State, Zip: (406) Phone Phone: (406) 37 - Fax Fax: By : JR Lanser By: Signature: Title: President Date: 1 September 2012 Signature: Title: Date: Page 10
11 CARRIER PROFILE Carrier Name Contact Information Dispatch Contact Dispatch Phone # Fax # After Hours Emergency # Cell Phone # Address Information Mailing Address City State Zip Physical Address City State Zip Billing Factoring Company / Contact Accounting Contact Accounting Phone Fax Accounting Address City State Zip EQUIPMENT & SERVICES (Check all that apply) Flatbed Refer Hazmat Swing Door 53 Van Logistics Van Heavy Hauler Blankets 48 Van Air Ride Lift Gate Teams Step Deck Bobtail Roll Up Door Other SERVICE AREAS (Check all that apply) Northwest ID-MT-OR-WA-WY North Central IA-MN-ND-NE-SD Great Lakes IL-IN-MI-OH-WI Northeast DE-MD-NJ-NY-PA-VA-WV-RI Southwest AZ-CA-CO-NM-NV-UT South Central AR-KS-LA-MO-OK-TX Southeast AL-FL-GA-KY-MS-NC-SC-TN OTHER FOR RJ S USE ONLY CARRIER ID Page 11
12 P.O. Box 2065, Hamilton, MT Phone Fax Workers Compensation Hold Harmless Agreement AGREES TO HOLD HARMLESS AND INDEMNIFY RJ S TRUCK BROKERAGE AND ANY OF ITS AFFILIATES AGAINST ANY AWARD BY A WORKERS COMPENSATION COURT, SIMILAR ADMINISTRATIVE BODY, OR COURT OF LAW. COMPANY SIGNATURE OF OFFICER DATE AND LOCATION
13 Attn: Accounts Receivable Our company requirements are as follows: We pay all of our carriers within days of receipt of invoice and BOL. All BOLS must be ed or faxed to our accounting dept within 24 hours of delivering the load. BOL must be submitted within 24 hours for payment. Please fill in Remit To information below: Factoring Company Yes No Name: Mailing Address: Accounting Contact Info Name: Anna Luhrsen Fax: We appreciate your services and wish to keep you as a valued carrier. Please follow this process for prompt payment. Thank you for your attention, Carrier: Signature: Page 13
14 REFERENCES Reference 1 Company Name Contact Phone Fax Relationship Reference 2 Company Name Contact Phone Fax Relationship Reference 3 Company Name Contact Phone Fax Relationship Any Additional Information FOR RJ S USE ONLY Verified References Page 14
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