owner-operator

Recommendations

Info

MOTOR VEHICLE DRIVER’S Certification of Violations/Annual Review of Driving Record CERTIFICATION OF VIOLATIONS—COMPLETED BY DRIVER Driver Name: (Please Print) Date of Employment Home Terminal(City and State) Driver’s License Number State Expiration Date I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months. Date of conviction Offense Location Type of motor vehicle operated If no violation are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months. Date of certification Driver’s Signature COMPLETED BY MOTOR CARRIER – ANNUAL REVIEW OF DRIVING RECORD MOTOR CARRIER: Each motor carrier shall, at least once every 12 months, require each driver it employs to prepare and fumish it with a list of all violations of motor vehicle traffic laws and ordinances (other than violations involving only parking) of which the driver has been convicted or on account of which he/she has forfeited bond or collateral during the preceding 12 months. (FMCSR 391.27) I have hereby reviewed the driving record of the above named driver in accordance with section 391.25 and find that he/she (check one): Meets minimum requirements for safe driving Is disqualified todrive a motor vehicle pursuant to Section 391.15 Does not adequately meet satisfactory safe driving performance Reviewed by: Signature Date Printed Name Title Motor Carrier Name Motor Carrier Address
LEASE AGREEMENT Note: This Lease Agreement should be maintained in the Equipment during the term of the Agreement. I. I, _________________________________________________________________________ (Carrier/Registrant) Address: _______________________________________________________________________________, and ___________________________________________________________________________(Equipment Owner) are parties to a written Lease Agreement (Agreement), whereby the Equipment Owner has leased to the Carrier certain motor vehicle equipment listed below, owned and controlled by the Equipment Owner, whereby the Equipment Owner is providing the Carrier as <strong>operator</strong> or <strong>operator</strong>s of the Equipment for the purpose of loading, transporting and unloading freight. II. The Original Agreement is on file at the Carrier’s General Office. A copy of this Lease Agreement and receipt for the Equipment must be carried on the Equipment as required by 49 CFR §376. Carrier verifies that the Equipment is being operated by the Carrier, pursuant to the terms of the Agreement. III. Equipment Owner/Equipment Information Name:___________________________________ Phone #: _______________________________________ DBA: ____________________________________ Contact:________________________________________ Address: _________________________________ FEIN: __________________________________________ _________________________________ Year: _______ Make: ____________________ VIN: ________________________________ Unit #: __________ IV. Duration of Lease Agreement and Termination The Lease Agreement shall begin on the date below and shall remain in effect until terminated by either party, giving notice to that effect. Notice may be given personally, by mail or by fax at the address or fax number shown in the Lease Agreement. MOTOR CARRIER/REGISTRANT By: ____________________________________________ Date: __________________________________________ EQUIPMENT OWNER By:____________________________________________ Date: __________________________________________ MC #:__________________________________________ USDOT #: ______________________________________ Printed by authority of the State of Illinois. November 2011 — 1 — VSD 683.2
Page 1 and 2: MEMBERSHIP APPLICATION APPLICANT: M
Page 3: APPLICANT CONSENT AND RELEASE FORM
Page 6 and 7: Name DRIVER'S APPLICATION FOR EMPLO
Page 8 and 9: ACCIDENT RECORD FOR THE PAST 3 YEAR
Page 10 and 11: Department of Homeland Security U.S
Page 12 and 13: Contract Driver NAIT Association Pr
Page 14 and 15: AGREEMENTS (CONTINUED) Applicable T
Page 16 and 17: ! Direct Deposit Authorization Form
Page 18 and 19: the Federal Highway Administration
Page 20 and 21: F. R2R Intermodal Inc. NOT LIABLE,
Page 22 and 23: Agreement, including, but not limit
Page 24 and 25: 13. Miscellaneous Provisions A. LAB
Page 26 and 27: Please supply IDES Account Number,
Page 28 and 29: Unauthorized Passengers To provide

owner-operator

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?