Tax ID: 27-317881 MC-741798-C SCAC: BWCD DOT: 2129517 Blackwell Consolidation, LLC Mailing PO Box 3667 Central Point, OR 97502 Corporate Location 5656 Crater Lake Ave. Central Point, OR 97502 Hours: 7:00-5:00 M-F Phone: 541-423-1210 Fax: 541-423-1213 Accounting Angie Peterson 541-618-6531 angie@blackwellfreight.com Jaci Fahring 541-618-6531 jfahring@combinedtransport.com Dispatch Rhonda Krasznavolgyi (Lead) 541-618-6574 rhonda@blackwellfreight.com Debra Wargnier (PNW) 541-618-6526 debra@blackwellfreight.com Marly Webber 541-618-6555 marly@blackwellfreight.com Randy Bray (Cal.) 541-618-6594 rbray@combinedtransport.com Sales Manager Kellie Duste 541-618-6525 kduste@combinedtransport.com Sales Coordinator Priscilla Zambrano-Anderson 541-618-6557 priscilla@blackwellfreight.com Shawlena Haga (W11-OTR) 541-618-6510 shaga@blackwellfreight.com
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 McGriff, Seibels & Williams of Oregon 1800 SW First Avenue, Suite 400 Portland, OR 97201 INSURED Combined Transport, Inc. Blackwell Consolidation, LLC 5656 Crater Lake Highway P.O. Box 3667 Central Point, OR 97502 INSURER F : COVERAGES CERTIFICATE NUMBER: TMYCCBG3 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A D B C X X COMMERCIAL GENERAL LIABILITY OTHER: CLAIMS-MADE AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAB X X CERTIFICATE OF LIABILITY INSURANCE OCCUR SCHEDULED AUTOS NON-OWNED AUTOS OCCUR CLAIMS-MADE 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 CARGO LEGAL LIABILITY Y-630-0710R943-TCT-15 EX-0710R943-TCT-15 RWE5000308-03 (XS) RWD5000309-03 (CA, IL & TX) MTC 9245266-03 INSURER A : The Travelers Indemnity Company of Connecticut INSURER B : XL Specialty Insurance Company INSURER C : Zurich American Insurance Company INSURER D : Travelers Property Casualty Company of America 06/01/2015 06/01/2016 06/01/2015 06/01/2016 06/01/2015 06/01/2016 06/01/2015 06/01/2016 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) DATE (MM/DD/YYYY) 05/21/2015 CONTACT NAME: PHONE FAX 503-943-6621 503-943-6622 (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER E : INSURER(S) AFFORDING COVERAGE EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE 25682 37885 16535 25674 100,000 5,000 2,000,000 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY JECT LOC X PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT Per Conveyance/Disaster NAIC # CERTIFICATE HOLDER 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 Evidence of Insurance ACORD 25 (2014/01) Page 1 of 1 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
ACORDTM CERTIFICATE OF LIABILITY INSURANCE PRODUCER American Trucking and Transportation Ins. Co., a Risk Retention Group 111 North Higgins Avenue, Suite 300A Missoula, Montana 59802 (406) 523-3934 INSURED Combined Transport, Inc. Blackwell Consolidation, LLC P.O. Box 3667 5656 Crater Lake Avenue Central Point, Oregon 97502 DATE (MM/DD/YYYY) 05/20/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A: American Trucking and Transportation Insurance Company Risk Retention Group INSURER B: N/A INSURER C: N/A 11534 COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) CLAIMS OCCUR MADE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG POLICY PRO- JECT LOC A AUTOMOBILE LIABILITY X ANY AUTO ATTCTI115 06/01/2015 05/31/2016 COMBINED SINGLE LIMIT (Ea accident) 5,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) X TRAILER INTERCHANGE 50,000 LIMIT PER TRAILER PROPERTY DAMAGE (Per accident) NON-TRUCKING LIABILITY GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA AUTO ONLY: ACC AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETARY/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below Other DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT CERTIFICATE HOLDER Evidence of Insurance CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL THIRTY (30) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) ACORD CORPORATION 1988
CREDIT APPLICATION COMPANY NAME: Federal I.D. #: Sole Proprietor, Partnership, Or Corporation: Attention: President or Owner s Name: Mailing Address: City: State: Zip: Physical Address: City: State: Zip: Phone #: Fax #: Yrs. in Business: # of Locations: # of Employees: If Corporation, Address of Corporate Headquarters: Accounts Payable Contact: Phone Number or Extension: Special Instructions: Bank Name: Bank Address: Bank Account Number: Trade Reference: Trade Reference: Trade Reference: Trade Reference: Dispatcher s Name: Bank Contact: CREDIT AGREEMENT: upon acceptance of this application, I/We agree to the following. In accordance with the I.C.C. regulations, all invoices must be paid within fifteen (15) days of invoice date, unless alternate arrangements have been made and agreed to in writing by all parties. Any account surpassing the agreed upon terms may have their credit privileges suspended until the account is paid in full. A 2% per month finance charge may be applied to all unpaid balances, as stated on each invoice. Combined Transport, Inc. reserves the right to seek pre and post-judgment interest from the date of invoice, at a rate of 24% annually, as well as court cost and attorney fees, if litigation ensues. PLEASE SIGN TO AUTHORIZE US THE RIGHT TO ALL CREDIT INQUIRES: Signature: Date: Please Print Name: Title:
ACH Set-up Information for Blackwell Consolidation, LLC. Bank Name: Wells Fargo Bank Address: 99 E Broadway City/State/Zip: Eugene, OR 97401 Contact Person: Yvonne Philibert Phone: 541-465-5558 Account: 4126705557 ABA: 121-000-248 SWIFT Code: WFBIUS6S Please provide Blackwell Consolidation s invoice number in the remittance email. Remittance Email: ar@blackwellfreight.com If you have any questions, or need further information, please contact Pam Hurley at 541-618-6568. Blackwell Consolidations, LLC
April 16, 2015 JON CARD BLACKWELL CONSOLIDATION LLC PO BOX 3667 CENTRAL POINT, OR 97502 CERTIFICATE OF STANDARD CARRIER ALPHA CODE (SCAC) RENEWAL The Standard Carrier Alpha Code of BLACKWELL CONSOLIDATION LLC PO BOX 3667 CENTRAL POINT, OR 97502 MC-741798 US DOT-2129517 BWCD has been renewed for: This Alpha Code will apply only to the company name shown above through June 30, 2016. Approximately two months prior to expiration of this SCAC, NMFTA will provide a renewal notice which must be promptly returned together with payment to ensure its continued validity. Should the company name or address change, please notify the National Motor Freight Association, Inc. at the address below. Alpha Codes ending with the letter "U" have been reserved for the identification of freight containers. If your Alpha Code ends with the letter "U", it should be used only for this purpose. A non-u ending Alpha Code should be obtained to satisfy other requirements such as company identification for Customs, Electronic Data Interchange, freight payments, etc. If you participate in the Bureau of Customs and Border Protection (BCBP) automated programs (ACE, AMS,CAFES, FAST, PAPS), your SCAC and related company information has been sent to BCBP electronically and is updated on a nightly basis. If you have encountered a problem using your SCAC with BCBP, or a copy this letter has been requested by BCBP, only then should you forward the requested information (email preferred as a PDF or TIF attachment) to the following address: CBP SCAC Processing Bureau of Customs and Border Protection 7681 Boston Blvd., Beauregard 1st Fl Wing A Springfield, VA 22153 AMS.SCAC@DHS.GOV NOTICE: Renewal of the above listed SCAC is unrelated to participation in the National Motor Freight Classification (NMFC). Further, it does not confer membership in the National Motor Freight Traffic Association, Inc. nor allow use of the NMFC inconnection with freight rates. For participation and membership information, please call (703) 838-1810 1001 North Fairfax Street Suite 600 Alexandria, VA 22314-1798 ph: 703.838.1810 fax: 703.683.1094 web: www.nmfta.org email: scac@nmfta.org