Combined Transport Inc. Contacts:

Combined Transport Inc.
Physical Address:
Mailing Address:
Tax ID: 94-2709226
MC 152144
SCAC: CMBD
Bank:
Wells Fargo Bank
99 E Broadway
Eugene, OR 97401
Contact: Yvonne Philibert (541) 465-5558
Contacts:
Accounting:
Marji Peterson
Financial Manager
(541) 734-7418 ext.6533
[email protected]
Accounts Payable
(541) 734-7418 ext.65
@combinedtransport.com
Sales Managers:
Scott Waggoner
(541) 734-7418 ext.6566
[email protected]
Michael Paradis
(541) 734-7418 ext.6575
[email protected]
Credit References:
M.D. Mullins Heavy Haul
PO Box 333
CRST Flatbed Inc.
10905 Hemlock Avenue
Fontana, CA 92337
Contact: Ruth or Al
System Transport, Inc.
PO Box 3456
Spokane, WA 99220
(509) 623-4000
Noble & Pitts
PO Box 13324
Birmingham, AL 35202
(256) 259-6719
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
11/05/2015
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).
CONTACT
NAME:
PHONE
(A/C, No, Ext): 503-943-6621
E-MAIL
ADDRESS:
PRODUCER
McGriff, Seibels & Williams of Oregon
1800 SW First Avenue, Suite 400
Portland, OR 97201
FAX
(A/C, No): 503-943-6622
NAIC #
INSURER(S) AFFORDING COVERAGE
INSURED
Combined Transport, Inc.
Blackwell Consolidation, LLC
5656 Crater Lake Highway
P.O. Box 3667
Central Point, OR 97502
INSURER A :The Travelers Indemnity Company of Connecticut
25682
INSURER B :Zurich American Insurance Company
16535
INSURER C :XL Specialty Insurance Company
37885
INSURER D :Travelers Property Casualty Company of America
25674
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE NUMBER:5WVB6M7V
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
LTR
A
TYPE OF INSURANCE
X
ADDL SUBR
INSD WVD
Y-630-0710R943-TCT-15
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
X
POLICY EFF
POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
POLICY NUMBER
06/01/2015
06/01/2016
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
PROX POLICY
LOC
JECT
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
1,000,000
$
100,000
MED EXP (Any one person)
$
5,000
PERSONAL & ADV INJURY
$
1,000,000
GENERAL AGGREGATE
$
2,000,000
PRODUCTS - COMP/OP AGG
$
2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
AUTOS
NON-OWNED
AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
$
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
D
UMBRELLA LIAB
X
C
B
X
EXCESS LIAB
EX-0710R943-TCT-15
OCCUR
DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
CARGO LEGAL LIABILITY
06/01/2015
06/01/2016
CLAIMS-MADE
EACH OCCURRENCE
$
4,000,000
AGGREGATE
$
4,000,000
$
RWE5000308-03 (XS)
RWD5000309-03 (CA, IL & TX)
06/01/2015
06/01/2016
X
PER
STATUTE
OTHER
$
1,000,000
E.L. DISEASE - EA EMPLOYEE $
1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
1,000,000
E.L. EACH ACCIDENT
MTC 9245266-03
06/01/2015
06/01/2016
Per Conveyance/Disaster
$
$
$
$
$
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
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.
Evidence of Insurance
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
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
DATE (MM/DD/YYYY)
06/01/2015
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.
American Trucking and Transportation Ins. Co., a
Risk Retention Group
111 North Higgins Avenue, Suite 300A
Missoula, Montana 59802
(406) 523-3934
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
INSURER A:
Combined Transport, Inc.
Cardmoore Trucking Ltd. Partnership
P.O. Box 3667
5656 Crater Lake Avenue
Central Point, Oregon 97502
Blackwell Consolidation, LLC
P.O. Box 3667
7111 Blackwell Road
Central Point, OR 97502
American Trucking and Transportation Insurance
Company Risk Retention Group
11534
INSURER B:
N/A
INSURER C:
N/A
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
ADD’L
POLICY EFFECTIVE
POLICY EXPIRATION
LTR
INSRD
TYPE OF INSURANCE
POLICY NUMBER
DATE (MM/DD/YY)
DATE (MM/DD/YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence)
CLAIMS
MADE
OCCUR
$
$
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN’L AGGREGATE LIMIT APPLIES PER:
PROPOLICY
JECT
LOC
AUTOMOBILE LIABILITY
A
X
PRODUCTS - COMP/OP AGG
ATTCTI115
06/01/2015
05/31/2016
COMBINED SINGLE LIMIT
(Ea accident)
$5,000,000
ANY AUTO
ALL OWNED AUTOS
$
BODILY INJURY
(Per person)
SCHEDULED AUTOS
HIRED AUTOS
$
BODILY INJURY
(Per accident)
NON-OWNED AUTOS
X
TRAILER INTERCHANGE
$50,000 LIMIT PER TRAILER
$
PROPERTY DAMAGE
(Per accident)
NON-TRUCKING LIABILITY
GARAGE LIABILITY
ANY AUTO
EXCESS/UMBRELLA LIABILITY
OCCUR
CLAIMS MADE
AUTO ONLY - EA ACCIDENT
OTHER THAN
EA
AUTO ONLY:
ACC
AGG
$
$
EACH OCCURRENCE
AGGREGATE
$
$
$
$
DEDUCTIBLE
RETENTION
$
$
$
WORKERS COMPENSATION AND
EMPLOYERS’ LIABILITY
ANY PROPRIETARY/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
WC STATUTORY LIMITS
OTHER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
Other
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL THIRTY (30)
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER
ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08)
© ACORD CORPORATION 1988
01/01/2015
P.O. Box 3667
Central Point, OR 97502
(541) 734-7418
(800) 547-2870
Fax (541) 826-1080
[email protected]
CREDIT APPLICATION
COMPANY NAME:
Federal I.D. #:
Attention:
President or Owner’s Name:
Sole Proprietor, Partnership, Or Corporation:
Mailing Address:
City:
State:
Zip:
Physical Address:
City:
State:
Zip:
Phone #:
Fax #:
If Corporation, Address of Corporate Headquarters:
Accounts Payable Contact:
Yrs. in Business:
# of Locations:
# of Employees:
Phone Number:
Fax Number:
Phone Number or Extension:
Special Instructions:
Bank Name:
Bank Contact:
Bank Address:
Phone Number:
Fax Number:
Bank Account Number:
Trade Reference:
Trade Reference:
Trade Reference:
Trade Reference:
Phone Number:
Fax Number:
Phone Number:
Fax Number:
Phone Number:
Fax Number:
Phone Number:
Fax Number:
Dispatcher’s Name:
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:____________________________
P.O. BOX 3667
CENTRAL POINT, OR 97502
ACCOUNTI NG DEPARTMENT
(541) 734-7418
(800) 547-2870
FAX (541) 826-1080
**** COMBINED TRANSPORT. INC****.
WIRE /ACH SET-UP INFORMATION
Bank Name:
Wells Fargo Bank
Address:
99 E. Broadway
City, State, & Zip:
Eugene, OR 97401
Contact Person at Bank: Yvonne Philibert
Bank Phone #:
541-465-5558
Account #:
4126705524
ABA #:
121-000-248
SWIFT CODE:
WFBIUS6S
Please provide Combined Transport’s invoice # in the remittance email.
Remittance E-Mail:
[email protected]
If you have any questions, or need any additional information, please contact Pam
Hurley, at: 541-618-6568
April 16, 2015
JON CARD
COMBINED TRANSPORT INC
PO BOX 3667
CENTRAL POINT, OR 97502-0029
CERTIFICATE OF STANDARD CARRIER ALPHA CODE (SCAC) RENEWAL
The Standard Carrier Alpha Code of CMBD has been renewed for:
COMBINED TRANSPORT INC
PO BOX 3667
CENTRAL POINT, OR 97502-0029
MC-152144
US DOT- 194077
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
[email protected]
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: [email protected]
UNITED STATES OF AMERICA
DEPARTMENT OF TRANSPORTATION
PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION
HAZARDOUS MATERIALS
CERTIFICATE OF REGISTRATION
FOR REGISTRATION YEAR(S) 2015-2018
Registrant:
COMBINED TRANSPORT, INC
Attn: JON CARD
PO BOX 3667
CENTRAL POINT, OR 97502
This certifies that the registrant is registered with the U.S. Department of Transportation as required by
49 CFR Part 107, Subpart G.
This certificate is issued under the authority of 49 U.S.C. 5108. It is unlawful to alter or falsify this
document.
Reg. No: 060315 552 035XZ
Issued: 06/03/2015
Expires: 06/30/2018
HM Company ID: 054772
Record Keeping Requirements for the Registration Program
The following must be maintained at the principal place of business for a period of three years from the
date of issuance of this Certificate of Registration:
(1) A copy of the registration statement filed with PHMSA; and
(2) This Certificate of Registration
Each person subject to the registration requirement must furnish that person’s Certificate of Registration
(or a copy) and all other records and information pertaining to the information contained in the registration
statement to an authorized representative or special agent of the U. S. Department of Transportation upon
request.
Each motor carrier (private or for-hire) and each vessel operator subject to the registration requirement
must keep a copy of the current Certificate of Registration or another document bearing the registration
number identified as the "U.S. DOT Hazmat Reg. No." in each truck and truck tractor or vessel (trailers
and semi-trailers not included) used to transport hazardous materials subject to the registration
requirement. The Certificate of Registration or document bearing the registration number must be made
available, upon request, to enforcement personnel.
For information, contact the Hazardous Materials Registration Manager, PHH-52, Pipeline and Hazardous
Materials Safety Administration, U.S. Department of Transportation, 1200 New Jersey Avenue, SE,
Washington, DC 20590, telephone (202) 366-4109.