W COLUMBIA ST SCHUYLKILL HAREN, PA (570) Business Fax: Fax: (570) P O BOX 268 POTTSVILLE, PA NO

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1 Addresses Business Business Phone: Mail Mail Phone: W COLUMBIA ST SCHUYLKILL HAREN, PA (570) Business Fax: Fax: (570) P O BOX 268 POTTSVILLE, PA Mail Fax: Undeliverable Mail: NO Authorities: Common Authority: ACTIVE Application Pending: NO Contract Authority: ACTIVE 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: BIPD on File: Cargo Exempt: NO Cargo Required YES Cargo on File: YES BOC-3: YES Bond Required: YES Bond on File: YES Blanket Company: NATIONAL RESIDENT AGENT SERVICE, INC. Comments: MCF-19439/TA FILED 6/20/89. Active/Pending Insurance: EDC : Effective Date: 06/28/2009 Cancellation Date: Posted Date: 06/22/2009 : NATIONAL INTERSTATE INSURANCE COMPANY ATTN: HOLLY HUMMEL 3250 INTERSTATE DRIVE RICHFIELD, OH US (800) Fax: (330) Form: 34 CARGO QT M253- Effective Date: 06/28/2008 : Cancellation Date: Posted Date: 06/25/2008 $5,000 : TRAVELERS PROPERTY CASUALTY CO. OF AMERICA PLEASE CONTACT YOUR LOCAL AGENT 1 TOWER SQUARE, 5GS HARTFORD, CT US Fax: Page 1 of 8

2 Active/Pending Insurance: Form: 84 SURETY Posted Date: 12/07/2004 S : $10,000 Effective Date: 09/20/2004 Cancellation Date: : WASHINGTON INTERNATIONAL INSURANCE COMPANY C/O ROANOKE TRADE, ATTN: STEVE KNUTSON 1475 E WOODFIELD RD., STE: 500 SCHAUMBURG, IL US (847) Fax: (847) 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. Rejected Insurances: Form: : Received: Rejected: Rejected Reason: $0 Page 2 of 8

3 CL /12/1991 To: 04/17/1991 EMPIRE FIRE & MARINE INSURANCE CO. FOR CLAIMS CALL: FNB PKWY. OMAHA, NE US (888) Fax: DXA /28/1996 To: 08/22/1997 AMERICAN INSURANCE CO. CAROLYN NICHOLS 777 SAN MARIN DRIVE NOVATO, CA US (714) Fax: (415) LTI /28/2006 To: 06/28/2007 LTI /28/2006 To: 05/28/2007 Page 3 of 8

4 LTI /28/2007 To: 06/28/2008 LTI /28/2005 To: 06/28/2006 LTI /28/2005 To: 04/28/2006 ATM /28/1998 To: 06/28/2004 CLARENDON NATIONAL INS. CO. DANNY GREEN 466 LEXINGTON AVENUE, SUITE 1900 NEW YORK, NY US (212) Fax: (212) Page 4 of 8

5 LTI /28/2004 To: 09/29/2004 SLLTI /29/2008 To: 06/28/2008 STATE NATIONAL INSURANCE CO., INC. DEBBIE VANSANFORD 8200 ANDERSON BLVD. FORT WORTH, TX US (817) Fax: (817) SLLTI /28/2008 To: 06/28/2009 STATE NATIONAL INSURANCE CO., INC. DEBBIE VANSANFORD 8200 ANDERSON BLVD. FORT WORTH, TX US (817) Fax: (817) KX /28/1997 To: 06/28/1998 PROVIDENCE WASHINGTON INSURANCE CO. LINDA STORM P.O. BOX 518 PROVIDENCE, RI US (401) Fax: (401) Page 5 of 8

6 LTI /29/2004 To: 06/28/2005 Form: 34 IF /12/1990 CARGO To: 06/28/1996 $5,000 LEXINGTON INSURANCE COMPANY EDWARD T. FOX 100 SUMMER ST., 30THFLR BOSTON, MA US (617) Fax: (866) Form: /28/1996 CARGO To: 06/23/2000 $5,000 LEXINGTON INSURANCE COMPANY EDWARD T. FOX 100 SUMMER ST., 30THFLR BOSTON, MA US (617) Fax: (866) Form: /23/2000 CARGO To: 06/28/2008 $5,000 LEXINGTON INSURANCE COMPANY EDWARD T. FOX 100 SUMMER ST., 30THFLR BOSTON, MA US (617) Fax: (866) Page 6 of 8

7 Form: /20/1990 SURETY To: 09/20/2004 $10,000 OHIO CASUALTY INSURANCE CO. DENISE MACKENDIRCK 9450 SEWARD ROAD FAIRFIELD, OH US (513) Fax: (513) Form: 84 S /20/2004 SURETY To: 09/20/2004 $10,000 WASHINGTON INTERNATIONAL INSURANCE COMPANY C/O ROANOKE TRADE, ATTN: STEVE KNUTSON 1475 E WOODFIELD RD., STE: 500 SCHAUMBURG, IL US (847) Fax: (847) 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. 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 CONTRACT CARRIER 05/30/ CONTRACT REJECTED 10/03/ BROKER 09/28/ CONTRACT DENIED 08/18/1988 Page 7 of 8

8 Authority History: Sub No. Authority Type Original Action Disposition Action 35 05/15/ /23/ /09/ /08/ /08/ /06/ /06/ /28/ /23/ /19/1980 Pending Application: Authority Type Filed Status Insurance BOC-3 Revocation History: Authority Type 1st Serve Date 2nd Serve Date Reason Page 8 of 8

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