To: Transportation Department RE: Logistics Packet Thank you for the opportunity to service your transportation needs. Attached are documents that will assist you in establishing Circle Logistics as your transportation provider. We have included: Operating Authority Certificate of Liability/Cargo Insurance Certificate of Worker s Compensation Insurance W-9 Phone: 260-208-4500 Fax: 317-324-9919 Federal ID# - 45-3296211 MC# - 299953 U.S. DOT# - 635676 Brokerage MC# - 761291 SCAC CLNC; Brokerage SCAC - CLIM Equipment Available Flats, Steps, Double Drops, Dry Van, Specialized General Email for a Quote dispatch@clinow.com Remit to address: P.O. Box 8067, Fort Wayne, IN 46898-8067 Transportation Key Contacts: Eric V. Fortmeyer, President (260) 208-4500, Ext. 1005 eric.fortmeyer@clinow.com Derek Holst, Operations Department (260) 208-4500, Ext. 1007 dholst@clinow.com Heath Bodkin, Driver Recruiting (260) 208-4500, Ext. 1001 hbodkin@circledelivers.com Thomas Pruesse, Safety Director (260) 208-4500, Ext. 1003 tpruesse@circledelivers.com Chad M. Buchanan, C.F.O. (260) 208-4500, Ext. 1004 chad@clinow.com Alan Scherer, Operations Department (260) 208-4500, Ext. 1015 ascherer@circlefreight.com Dustin Kissling, Credit Department (260) 208-4500, Ext. 1033 dkissling@circledelivers.com Yolanda Gonzalez, Office Manager (260) 208-4500, Ext. 1025 ygonzalez@circledelivers.com P.O. Box 8067 * Fort Wayne, IN 46898-8067 Phone: 260-208-4500 * Fax: 317-324-9919 * Email: dispatch@clinow.com
U.S. Department of Transportation Federal Motor Carrier Safety Administration 1200 New Jersey Ave., S.E. Washington, DC 20590 SERVICE DATE October 07, 2011 LICENSE MC-761291-B CIRCLE LOGISTICS INC FORT WAYNE, IN This License is evidence of the applicant's authority to engage in operations, in interstate or foreign commerce, as a broker, arranging for transportation of freight (except household goods) by motor vehicle. This authority will be effective as long as the broker maintains insurance coverage for the protection of the public (49 CFR 387) and the designation of agents upon whom process may be served (49 CFR 366). The applicant shall also render reasonably continuous and adequate service to the public. Failure to maintain compliance will constitute sufficient grounds for revocation of this authority. Jeffrey L. Secrist, Chief Information Technology Operations Division BPO
ACORDTM PRODUCER INSURED CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: PRODUCER CUSTOMER ID #: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY GWP91146D 01/01/2015 01/01/2016 EACH OCCURRENCE DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG PRO- X POLICY JECT LOC AUTOMOBILE LIABILITY GWP91146D 01/01/2015 01/01/2016 COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) X ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Value 30,000 RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 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). Marvin Johnson & Associates 305 Washington St P.O. Box 1849 Columbus, IN 47201 A CIRCLE LOGISTICS INC P.O. BOX 8067 FORT WAYNE, IN 46898-8067 X INSURER(S) AFFORDING COVERAGE NAIC # CLAIMS-MADE OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE X Trlr Interchnge Client#: 43618 OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE DEDUCTIBLE 01/05/2015 Michelle Eder FAX 812 372-0841 (A/C, No): 812 348-7474 meder@mjai.com Great West Casualty Company Travelers Insurance Comp/Coll B Cargo QT6600E946694 01/01/2015 01/01/2016 Limit 250,000 Deductible 2,500 11371 36161 100,000 5,000 1,000,000 1,000 Ded CERTIFICATE HOLDER Circle Logistics, Inc. P.O. Box 8067 Fort Wayne, IN 46898 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 (2009/09) 1 of 1 #S1229131/M1229125 Oc 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CLASS90050