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Owner Operator

    First Name
    Last Name

      If you are doing business with a name other than your given name, please enter

        ext.

          Street
          Apt# / PO Box
          City
          StatePostal Code

              Please check off the items that apply.

                Please let us know if you have experience with below

                  A Background Check and Drug Test will be required; pleaase let us know if we will find any of below.

                    If you wish to explain or give detail on any of above, use this space

                      Operating Authority

                      Please provide your Operating Authority information.

                                  Minimum insurance requirements include: o Cargo Liability - $100,000 per vehicle. o General Liability-$1,000,000 o Combined Automobile Liability - $1,000,000 per occurrence.

                                    If not included in your Insurance file, please upload your Workers Comp Insurance. Please note we require you provide your own workers comp to enter into business with J&D Transportation, Inc.

                                      Use this to upload your tariff rates, if any.

                                        Business References

                                        Please give us information on your current / past business references. We require 3 years of background. If you have it on file, you can upload. If not, please enter information in fields below.

                                          If you have a file with your Business References, please upload, if not, please continue below.

                                            Company name

                                              Street
                                              Apt# / PO Box
                                              City
                                              StatePostal Code

                                                Name of referral contact

                                                First Name
                                                Last Name

                                                  ext.

                                                        Are you currently hauling for this company?

                                                          Company name

                                                            Street
                                                            Apt# / PO Box
                                                            City
                                                            StatePostal Code

                                                              Name of referral contact

                                                              First Name
                                                              Last Name

                                                                    Are you currently hauling for this company?

                                                                      If you need more space to add your references to fullfill the minimum of 3 years background requirment, please use this space. Follow the above format.

                                                                        Agreement

                                                                        Contractor enters into this Agreement, and will remain throughout the term of the Agreement, as an independent contractor. Contractor agrees that he/she/it is not and will not become an employee, partner, agent, or principal of COMPANY while this Agreement is in effect. Contractor agrees he/she/it is not entitled to the rights or benefits afforded to COMPANY'S employees, including disability or unemployment insurance, workers' compensation, medical insurance, sick leave, or any other employment benefit. Contractor is responsible for providing, at his/her/its own expense, disability, unemployment, vehicle, cargo, trailer interchange, liability, workers' compensation, and other insurance, training, permits, vehicle maintenance and repair, vehicle lease, rental or loan payment, vehicle fuel and fluids, taxes, and licenses for himself/herself/itself and for his/hers/its employees and subcontractors. Contractor agrees to review and sign an Owner Operator Agreement at time of contracting which will detail above mentioned information and advise Rate of Compensation, Legal Compliance, Insurance, Expenses, and other details establishing the vendor / company relationship. Contractor agrees to allow below name entry as a digital signature for above mentioned.

                                                                          First Name
                                                                          Last Name

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