FMCSA Motor Carrier. DBA (Doing-Business-As) Name. Addresses Business Address: 1107 E. ELM ST. #C FULLERTON, CA Business Phone: Mail Address:
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1 Addresses Business Business Phone: Mail 1107 E. ELM ST. #C FULLERTON, CA (714) Business Fax: Mail Phone: Mail Fax: Undeliverable Mail: NO Authorities: Common Authority: INACTIVE Application Pending: NO Contract Authority: NONE Application Pending: NO Broker Authority: ACTIVE Application Pending: NO Property: YES Passenger: NO Household Goods: NO Private: NO Enterprise: NO Insurance Requirements: BIPD Exempt: NO BIPD Waiver: NO BIPD Required: $750,000 BIPD on File: $0 Cargo Exempt: NO Cargo Required YES Cargo on File: NO BOC-3: YES Bond Required: YES Bond on File: YES Blanket Company: TRUCK PROCESS AGENTS OF AMERICA, INC Comments: Active/Pending Insurance: Form: 84 SURETY Posted Date: 03/03/ : $10,000 Effective Date: 03/29/2009 Cancellation Date: : AMERICAN CONTRACTORS INDEMNITY COMPANY CHERYL CHUDO 601 S. FIGUEROA STREET, SUITE 1600 LOS ANGELES, CA US (800) Fax: (310) Note: If a carrier is in compliance, the amount of coverage will always be shown as the required Federal minimum ($5,000 per vehicle, $10,000 per occurrence for cargo insurance and $10,000 for bond/trust fund). The carrier may actually have higher levels of coverage. Page 1 of 5
2 Rejected Insurances: Form: : Received: Rejected: Rejected Reason: $0 Page 2 of 5
3 Insurance History: BIPD/Primary CA /10/2001 To: 09/26/2001 Disposition: Replaced $750,000 PROGRESSIVE CASUALTY INSURANCE COMPANY CUSTOMER SERVICE P.O. BOX CLEVELAND, OH US (800) Fax: (440) BIPD/Primary CA /10/2000 To: 06/10/2001 $750,000 PROGRESSIVE CASUALTY INSURANCE COMPANY CUSTOMER SERVICE P.O. BOX CLEVELAND, OH US (800) Fax: (440) BA /26/2001 BIPD/Primary To: 05/10/2005 $1,000,000 WILSHIRE INSURANCE COMPANY DAVID MATOUSEK 302 SOUTH 36 ST., P.O. BOX 3328, OMAHA, NE US (800) Fax: (661) Form: 34 CARGO #3AM /10/2000 To: 09/26/2001 Disposition: Replaced $5,000 AMERICAN MOTORISTS INSURANCE CO. ELLEN KNAPCIK ONE KEMPER DRIVE LONG GROVE, IL US (847) Fax: (847) Page 3 of 5
4 Insurance History: Form: 34 BA /26/2001 CARGO To: 05/10/2005 $5,000 WILSHIRE INSURANCE COMPANY DAVID MATOUSEK 302 SOUTH 36 ST., P.O. BOX 3328, OMAHA, NE US (800) Fax: (661) Form: /27/2003 SURETY To: 03/29/2009 $10,000 AMERICAN CONTRACTORS INDEMNITY COMPANY CHERYL CHUDO 601 S. FIGUEROA STREET, SUITE 1600 LOS ANGELES, CA US (800) Fax: (310) If a carrier is in compliance, the amount of coverage will always be shown as the required Federal minimum ($5,000 per vehicle, $10,000 per occurrence for cargo insurance and $10,000 for bond/trust fund). The carrier may actually have higher levels of coverage. If a carrier is in compliance, the amount of coverage will always be shown as the required Federal minimum ($5,000 per vehicle, $10,000 per occurrence for cargo insurance and $10,000 for bond/trust fund). The carrier may actually have higher levels of coverage. Authority History: Sub No. Authority Type Original Action Disposition Action MOTOR PROPERTY COMMON CARRIER GRANTED 06/28/2000 REVOKED 05/16/2005 PROPERTY BROKER GRANTED 03/05/2003 Pending Application: Authority Type Filed Status Insurance BOC-3 Page 4 of 5
5 Revocation History: Authority Type 1st Serve Date 2nd Serve Date Reason COMMON 04/13/ /16/2005 INVOLUNTARY REVOCATION Page 5 of 5
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INFORMATIVE Checklist Thank you for choosing to work with us! In the top right corner of each document, there will be a box to let you know which documents are required to be filled out and return in order
More informationLast name First name MI. Apt / Suite / PO box number Gender m Female m Male Language of choice m English m Spanish City State Zip code County / Parish
Large group employee enrollment form The offering company(ies) listed on the signature page, severally or collectively, as the content may require, are referred to in this application as Humana. Print
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DRIVER'S APPLICATION FOR EMPLOYMENT Applicant Name (print) Company Executive Transportation/Airport Shuttle/Charter of Application Address City State Zip Email: In compliance with Federal and State equal
More informationNOTICE OF CANCELLATION OF THE MASSACHUSETTS AUTOMOBILE INSURANCE POLICY
Name and Address of Insurance Company: NOTICE OF CANCELLATION OF THE Date of this Notice: NAME AND ADDRESS OF INSURED: VIN Number Effective Date of Cancellation: Policy Number: Registration Number Specific
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