5. W-9 Form including taxpayer identification number. (W8-BEN for Canada) 6. U.S. Motor Carrier Authority / Canadian Authority (If applicable)

Size: px

Start display at page:

Download "5. W-9 Form including taxpayer identification number. (W8-BEN for Canada) 6. U.S. Motor Carrier Authority / Canadian Authority (If applicable)"

Jacob Alban Booth
5 years ago
Views:

1 Logistic Dynamics, Inc Wehrle Drive Amherst, NY Phone: Ext (Agent Support) Website: Dear Carrier Applicant: Thank you for your interest in becoming an approved carrier for Logistic Dynamics, Inc. and our ever-growing network of quality carriers throughout North America. In order for us to assist you in getting setup as an approved carrier please complete and return the following information: 1. Insurance Certificate See attached letter that you can forward to your insurance company/agent. 2. Carrier Safety Questionnaire 3. Carrier Profile 4. Transportation Brokerage Contract 5. W-9 Form including taxpayer identification number. (W8-BEN for Canada) 6. U.S. Motor Carrier Authority / Canadian Authority (If applicable) 7. Hazmat Registration (If Hazmat Certified) If you have any questions, please call us at and enter extension 1402 for agent support. Please return this information by fax to Carrier Development (716) We appreciate your interest and look forward to working with you! Sincerely, Logistic Dynamics, Inc. Carrier Development

Logistic Dynamics Carrier Portal Logistic Dynamics Carrier Portal features streamlined load searching, truck posting, payment status and other valuable tools and resources to make your

aspx If you have any questions in the meantime, please contact our Carrier Development Team at carrierdev@logisticdynamics.com Why LDi?

2 Logistic Dynamics Carrier Portal Logistic Dynamics Carrier Portal features streamlined load searching, truck posting, payment status and other valuable tools and resources to make your online relationship with Logistic Dynamics even better. All for FREE! Register now at If you have any questions in the meantime, please contact our Carrier Development Team at Why LDi? Logistic Dynamics is a First Advantage Gold Book Broker and an active TIA member in good standing. We appreciate all the hard work our carrier partners do and take pride in paying our carriers on-time!!! Payment Options: Standard = Under 30 days 1 Day Quick Pay = 1 business day less 5% 5 Day Quick Pay = 5 business days less 3%

3 INSURANCE CERTIFICATE REQUEST ATTENTION CARRIER APPLICANT PLEASE FAX THIS TIME-SENSITIVE LETTER TO YOUR INSURANCE AGENT!!! To: Insured: Re: Carrier s Insurance Agent Carrier s Company CERTIFICATE OF INSURANCE Dear Insurance Agent: This fax is to request a signed, Certificate of Insurance on the above Insured. Please include the following information: 1. U.S. Coverage (whichever applies): Auto Liability (minimum 1,000,000 policy U.S. Funds) Cargo Liability (minimum of 100,000 policy U.S. Funds) Workman s Comp (minimum 500,000 limit, 100,000 Employee, 100,000 Accident Canadian Coverage (whichever applies): Auto Liability (minimum 2,000,000 policy U.S. Funds) Cargo Liability (minimum of 200,000 policy U.S. Funds) 2. Please make out the certificate to the following company: Logistic Dynamics, Inc Wehrle Drive Amherst, NY Fax: It is required that the above-listed company in Item 2 be named as ADDITIONALLY INSURED or be named CERTIFICATE HOLDER with a 30-day cancellation notice. The certificate must be signed! 4. Please indicate whether the Insured has ALL RISK or the BROAD FORM type of cargo insurance. Note to Insurance Agents Please FAX the requested information to: Carrier Development: Should you have any questions, please call Ext and we will be glad to help you. Thank you foryour help!

4 Carrier Safety Questionnaire Doc. Version /22/07 Carrier Legal Name: MC# Operations Manager: Phone: ( ) - Ext: Phone 2: ( ) - Fax: ( ) Does your company have established safety standards/policies for drivers and employees? Yes or No (Circle One) 2. What is your safety rating per the FMCSA? Satisfactory - Unsatisfactory Conditional - None (Circle one) 3. What is your safety director s name and phone number? Name: Phone: ( ) - Print Name: Date: Signature: PLEASE NOTE WE WILL NOT RELEASE ANY CARRIER PAYMENT UNLESS THIS FORM IS COMPLETED!!!!!!!!!!!

Remit to Address (If different from above): Dispatch: ( ) Main: ( ) Fax: ( ) Contact Name(s): Phone :( ) Email(s): Claims Contact: Phone: ( ) Email: Do you want online access to our available loads?

5 LOGISTIC DYNAMICS, INC. Carrier profile 1140 Wehrle Drive Toll Free: Amherst, NY Fax: PAYMENT WILL NOT BE RELEASED IF PROFILE IS NOT COMPLETED By completing our carrier profile you re helping us identify your distinct freight needs Company Name: MC# SCAC Code: Mailing Address: Remit to Address (If different from above): Dispatch: ( ) Main: ( ) Fax: ( ) Contact Name(s): Phone :( ) (s): Claims Contact: Phone: ( ) Do you want online access to our available loads? Yes No Address: If you need assistance with back haul lanes, please tell us about your available equipment and any services you offer so we may better serve you. Is your company C-TPAT Certified? If YES, please provide SVI number and fax certification to Is your company HAZMAT Certified? Is your company participating in the U.S. Government EPA Smart Way Program? How do you track your drivers? GPS Cell Phone Other: If GPS, can LDI have access online? Yes No Please check the states in which your company looks for freight UNITED STATES Please check the states in which your company requires as destinations UNITED STATES ST ST ST ST ST ST ST ST ST ST AK GA MA NM SD AK GA MA NM SD AL ID MI NY TN AL ID MI NY TN AR IL MN NC TX AR IL MN NC TX AZ IN MS ND UT AZ IN MS ND UT CA IA MO OH VT CA IA MO OH VT CO KS MT OK VA CO KS MT OK VA CT KY NE OR WA CT KY NE OR WA DE LA NV PA WV DE LA NV PA WV DC ME NH RI WI DC ME NH RI WI FL MD NJ SC WY FL MD NJ SC WY Top three Backhaul Lanes needing assistance with (City, ST): ORIGIN DESTINATION to to to 1

6 EQUIPMENT INFORMATION BREAKDOWN: NUMBER & SIZE OF EACH TRAILER CATEGORY 20' 25' 40' 45' 48' 53' 57' TOTAL VAN: Dry (V) Dry Vented (VV) Plate (PT) Curtain Side (CS) Tautliner (SS) Pup (P) Furniture (FV) Straight Truck (STR) Airride TOTAL REEFERS: TOTAL FLATBED: Step Deck (SD) Double Drop (DD) Flat Air (FA) Hotshot (HS) Flatbed with Sides (FS) Stretch Trailer (ST) Maxi (MX) RGN Please fill out the equipment information below Total # of Tractors: Total # of Vans: Total # of Reefers: Total # of Flatbeds: Do you offer any of the following services? Power Only: Yes No Satellite Equipped: Yes No Team Drivers: Yes No Drop Trailer: Yes No Expedited Service: Yes No Alcohol Permits: Yes No Heavy Haul: Yes No Van-Equipment Accessories E-Trac Heaters Decking Lift gate Garment Pads/Blanket Wrap Pallet Jack Roller Floor By completing our carrier profile you re helping us identify your distinct freight needs 2

7 Transportation Brokerage Contract 1 A CONTINUING CONTRACT to comply with the Negotiated Rates Act of 1993 & 1995; hereinafter referred to as the ACT ; for Transportation Services between Logistic Dynamics, Inc., MC located at 1140 Wehrle Drive, Amherst, NY 14221; hereinafter referred to as The Broker, and FHWA contract Motor Carrier. Carrier Name: MC# Address: City: St: Zip: Phone: Fax: A. CARRIER REPRESENTS AND WARRANTS THAT IT: 1. Is a Registered Motor Carrier of Property authorized to provide transportation of property under contracts with shippers and receivers and/or brokers of general commodities; 2. Has valid insurance with the following minimum limits: Public liability of 1,000,000; property damage of 1,000,000; cargo damage/loss of 100,000; workers compensation with limits required by law. Except for higher limits specified above, the insurance policy complies with minimum requirements of the Federal Motor Carrier Safety Agency and any other applicable regulatory agency. Exclusions in any insurance policy shall not exonerate carrier from liability. 3. Has a Satisfactory safety rating issued by the Federal Motor Carrier Safety Administration, U.S. Department of Transportation, and will notify Broker in writing immediately of any changes in the rating; 4. Is in compliance with all applicable state, federal and local laws related to the provisions of its services and the performance of this Agreement. 5. Shall name Broker as additionally insured and/or certificate holder on cargo and liability insurance acord 6. Will notify Broker immediately if Carriers Federal Operating Authority is revoked, suspended or rendered inactive for any reason; and/or if Carrier is sold, or if there is an change in control of Carrier. 7. Will not insert, nor authorize a shipper to insert Broker s name on a Bill of Lading as the shipper or carrier without Broker s express written consent. 8. Will defend, indemnify and hold harmless Broker and its customers harmless from any claims, losses, damages, liability of any kind arising out of the Carrier s performance or violation of any of the terms of this Agreement. Broker reserves the right to control the defense of any such matters, including the right to designate counsel. 9. Agrees not to assign, co-broker, double broker, trip lease, interline or warehouse shipments hereunder, without prior written consent from Logistic Dynamics, Inc. If Carrier breaches this provision Broker shall have the right to pay the actual delivering party directly for services rendered in lieu of original Carrier contracted by Broker. Payment to delivering party does not release Carrier from any liability to Broker or Shipper under this agreement. 10. Will meet the Distinct Shippers needs of Brokers freight; 11. Broker is the sole party responsible for payment of Carrier s invoices and that, under no circumstances will Carrier seek payment from the shipper or consignee; 12. Agrees to not back solicit freight shipments of any kind from customers of Broker, when: (a) the availability of such shipments first became known to Carrier as a result of Broker s efforts; and/or (b) where the shipments of Broker s customer were tendered to Carrier by the Broker prior to the Carrier s delivery of any freight for said customer. As liquidated damages, Carrier agrees to pay Broker twenty percent (20%) commission on all traffic handled by customers first introduced to Carrier by Broker for a period year following the cancellation of this Agreement. Additionally, Broker may seek injunctive relief and in the event it is successful, Carrier shall be liable for all costs and expenses incurred by Broker related to thereto, including, but not limited to reasonable attorney s fees. (Transportation Brokerage Contract Continued See Page 2) Logistic Dynamics, Inc Wehrle Dr., Buffalo, NY Toll-Free FREIGHT (3734) Ph:

8 (Transportation Brokerage Contract Page 2) 2 B. BROKER RESPONSIBIITIES 1. Broker agrees to pay Carrier the rate posted on the Fax as Contracted Rate Addendum Pick-up and Rate Confirmation prior to consignment; 2. Broker agrees to pay Carrier for services rendered within 30 days of Brokers receipt of Carriers invoice and original proof of delivery (POD). Broker is not liable for freight or related charges where proof of delivery has been delayed for more than 30 days after the delivery date. 3. Broker, as shipper will tender a Series of shipments to Carrier. C. MISCELLANEOUS 1. It is understood and agreed that the relationship between Broker and Carrier is that of any independent contractor and that no employer/employee relationship exists, or is intended. Broker has no control of any kind over Carrier, including but not limited to routing of freight, and nothing contained herein shall be construed to be inconsistent therewith. 2. Either party of this contract may invalidate it with written notice within 24 hours for any reason; otherwise, this is a Continuing Contract: for transportation. Logistic Dynamics, Inc (Broker) By: Dennis Brown (Printed) (Authorized Signature) President (Title) (Carrier Name) By: (Printed) (Authorized Signature) (Title) Logistic Dynamics, Inc Wehrle Dr., Buffalo, NY Toll-Free FREIGHT (3734) Ph:

9 Form W-9 Request for Taxpayer (Rev. January 2003) Identification Number and Certification Department of the Treasury Internal Revenue Service Print or type See Specific Instructions on page 2. Name Business name, if different from above Check appropriate box: Address (number, street, and apt. or suite no.) City, state, and ZIP code List account number(s) here (optional) Give form to the requester. Do not send to the IRS. Individual/ Exempt from backup Sole proprietor Corporation Partnership Other withholding Requester s name and address (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note: If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Part II Certification Under penalties of perjury, I certify that: Social security number or Employer identification number 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. person (including a U.S. resident alien). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Here Signature of U.S. person Purpose of Form A person who is required to file an information return with the IRS, must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. U.S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. Note: If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester s form if it is substantially similar to this Form W-9. Foreign person. If you are a foreign person, use the appropriate Form W-8 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Date Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a saving clause. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the recipient has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Cat. No X Form W-9 (Rev )

10 LOGISTIC DYNAMICS, INC. BILLING & CREDIT INFORMATION All freight bills should be mailed to: Logistic Dynamics, Inc Wehrle Drive Buffalo, NY Corporate Headquarters: MC# Federal Tax ID# DUNS# SCAC: LDYN CREDIT REFERENCES & DETAILS BELOW: Bank Information Surety Bond HSBC Bank USA, N.A. TIA Surety Holder One HSBC Center 1625 Prince Street, Suite 200 Buffalo, NY Alexandria, VA Phone: Phone: Fax: Account# Contact: Jerry Jacobi CARRIER REFERENCES Roane Transportation Services PO Box 665 Rockwood, TN Phone: Fax: Contact: Matt Bright Great American Lines PO Box Trafford Road Murrysville, PA Phone: x131 Fax: Contact: Amy Wright Go To Logistics 1215 Dunamon Drive Bartlett, IL Phone: x234 Fax: Contact: Kate Jurkowska

12 Logistic Dynamics, Inc. In good standing through September 30, 2012 Certificate #

13 Logistic Dynamics, Inc. Valid through October Bond , with a limit of 100,000.00

14 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR OCCUR CLAIMS-MADE EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG EACH OCCURRENCE AGGREGATE DATE (MM/DD/YYYY) 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 Avalon Risk Management 150 Northwest Point Boulevard, 4th Floor Elk Grove Village, IL INSURED Logistics Dynamics Inc Wehrle Drive Buffalo, NY 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 INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS 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 CONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) WC STATU- TORY LIMITS E.L. EACH ACCIDENT FAX (A/C, No): INSURER(S) AFFORDING COVERAGE Great American Alliance Insurance Company OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT 8/16/11 NAIC # TIA Performance Certified Program Great American Alliance /14/ /13/ ,000 Bond Insurance Company DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Excess coverage for claims exceeding the 10,000 BMC-85 broker trust fund agreement of the FMCSA licensed property broker named herein as the Insured. See bond terms for scope of coverage. CERTIFICATE HOLDER Evidence of coverage for benefit of shippers and carriers of Named Insured only. 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

Countrywide Express Inc.

Countrywide Express Inc. CUSTOMER APPLICATION At Countrywide Express our mission is to establish long lasting partnerships with customers in North America by providing best in class transportation solutions,