Owner Operator Forms

LIBERTY HAULILNG, INC.

P.O. BOX 503

POLK CITY, FL 33868

Office (863) 984-1462

Fax (863) 984-1542

Dispatch (863)-412-3081

THE FOLLOWING INFORMATION IS REQUIRED FOR EACH UNIT/TRUCK.

FAX TO (863) 984-1542

1. UNIT/TRUCK NUMBER AND SIGNED WORK AGREEMENT.

2. CURRENT COPY OF INSURANCE CERTIFICATE

LIABILITY $1,000,000 WITH EFFECTIVE AND EXPIRATION DATE AND SERIAL # FOR EACH UNIT

3. COPY OF REGISTRATION FOR EACH UNIT.

4. COPY OF DRIVERS CDL AND MEDICAL CARD FOR EACH UNIT.

5. COMPLETED W-9 FORM

6. CONTACT PHONE NUMBERS FOR OWNERS. TRUCK OPERATOR MUST HAVE A CELL PHONE

OR NEXTEL 2-WAY.

7. PRE OPERATING REQUIREMENT: DOT DRUG TEST

8. COPY OF DBE/MBE CERTIFICATES. IF YOU'RE A MINORITY & DO NOT HAVE A MINORITY CERTIFICATE APPLICATIONS ARE AVAILABLE BELOW.

FORMS ARE AVAILABLE BY CLICKING ON THE LINKS BELOW. COMPLETE FORMS AND FAX TO LIBERTY HAULING.