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CARRIER INFORMATION

CARRIER INFORMATIONP lease return the following: Company profile/contact INFORMATION Signed and initialed (each page) contract insurance certificate with USL listed as holder (USL, Box 14309, Cincinnati, OH 45250) Signed/completed W9 Copy of your certificate of authority Copy of a voided check (for direct deposit only)Send all required documents to: or use our online portal at: Box 14309, Cincinnati, OH 45250 Third Bank 38 Fountain Square Plaza, Cincinnati, OH 45263 | Duns: 82-601-9254 | Fed ID: 26-1768346US Logistics Dispatcher you re working with: _____ CARRIER InformationCOMPANY INFORMATIONC ompany NameStreet AddressCity/State/ZipDOT#MC#Smartway Certified?DISPATCHER INFORMATIONC ontact NameEmailPhoneACCOUNTING INFORMATIONC ontact NameEmailPhonePAYMENT AUTHORIZATIONP lease check box to choose one option below:n QUICK PAY 1 DAY5% deduction by comchek only (see instructions to the right)Our 1 day pay term requires a 24 hour, business day processing time.

Insurance certificate with USL listed as holder (USL, P.O. Box 14309, Cincinnati, OH 45250) ... 1.2 “Customer” is any business entity or individual which is the owner of cargo, property or other items ... specifically agrees that no released value classification or limitation of liability shall be applicable to any

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14 14.1. If any Increased Value insurance is effected by the Assured on the cargo insured herein the agreed value of the cargo shall be deemed to be increased to the total amount insured under this insurance and all Increased Value insurances covering the loss, and liability under this insurance shall be in such proportion as the sum insured ...

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operated or for the passengers or type of cargo being transported • Use of an electronic device while driving.(AS 28.33.190(16)(H) ... The evidence must be in the form of a policy or certificate of insurance by an insurer acceptable to the Department, or other security approved by the Department. ... The value specified by the manufacturer as ...

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and ‘Cargo type’ is ‘C’ or ‘CO’) ‘Containers’ refers to the sea cargo containers. 25. Invoice currency (mandatory) 26. FOB currency (mandatory) i.e. Australian dollars, etc. 27. Total FOB value (mandatory) The total free on board (FOB) value of the goods, including all costs

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COMMERCIAL INSURANCE APPLICATION DATE …

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