acceptable worker’s compensati

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Artisan Logistics Inc | E: [email protected] | P: 803-712-4931 Return all pages using the link provided in the original email - http://www.artisanlogistics.net/setup A valid insurance certificate listing certificate holder: Artisan Logistics, 1 Windsor Cv, STE 403, Columbia, SC 29223 Current coverage with minimum amounts of o $100,000 cargo coverage o $1,000,000 auto liability o Acceptable Worker’s Compensation An ACH form from your bank or voided check (IF QUICK PAY) Operating Authority W9 (OR FILL OUT THIS DOCUMENT) A copy of your Haz-Mat certificate (if applicable)

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Page 1: Acceptable Worker’s Compensati

Artisan Logistics Inc | E: [email protected] | P: 803-712-4931

Return all pages using the link provided in the original email -

http://www.artisanlogistics.net/setup

● A valid insurance certificate listing certificate holder:

Artisan Logistics, 1 Windsor Cv, STE 403, Columbia, SC 29223

● Current coverage with minimum amounts of

o $100,000 cargo coverage

o $1,000,000 auto liability

o Acceptable Worker’s Compensation

● An ACH form from your bank or voided check (IF QUICK PAY)

● Operating Authority

● W9 (OR FILL OUT THIS DOCUMENT)

● A copy of your Haz-Mat certificate (if applicable)

Page 2: Acceptable Worker’s Compensati

Bibby Transportation Finance, Inc. 555 Marriott Drive, Suite 240 • Nashville, TN • 37214

T: 615-574-7500 • F: 615-574-7515 • www.Bibbyusa.com

Bibby Transportation Finance Payment Methods

On behalf of Artisan Logistics Inc , Bibby Transportation Finance will be making direct payments to carriers via the following methods:

__________ Check via First Class Mail for $5.00 per check (payment processed 14 days after receipt of all required paperwork)

__________ *2 Day Quick Pay - Comcheck via express code for $12 fee (payment processed 1-2 business days after receipt of all required paperwork)

__________ *2 Day Quick Pay – Domestic Wire transfer to your account for $12 per wire (payment processed 1-2 business days after receipt of all required paperwork) *International Wire Fee- $25 ***Please attach a copy of you Company Voided Check for Wire Transfers***

Bank name: __________________________ Address: __________________________ (bank address required)

__________________________ Phone No.: __________________________

Routing/ABA #: _______________________________________ Account#: ____________________________________________

Please mark the preferred option above and complete the following information to return with your carrier packet.

Carrier name: ______________________________________

Carrier MC# ______________________________________

Carrier Remit Address: _______________________________

___________________________________________________________

Phone Number: ________________ Email address: ___________________________________

(email required if requesting Quick Pay via Comcheck)

We factor, please remit payment to:

__________________________________________________

__________________________________________________

__________________________________________________

Signature: _________________________ Date: ____________

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THIS FORM MUST BE COMPLETED TO BE PAID!
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* Quick Pay transactions are also charged 3% fee per Artisan Logistics Inc carrier agreement.
Page 3: Acceptable Worker’s Compensati

ARTISAN LOGISTICS INC.

Workers’ Compensation Hold Harmless Document

__________________________________________________(“Carrier”) agrees to hold harmless and indemnify ARTISANLOGISTICS INC. and any of its affiliated companies against any award by a Workers’ Compensation Court or similar administrative body or court of law, arising out of claims by any employee or agent of Carrier for work-related injuries.

__________________________________ (Carrier)

By:_______________________________

Name:_____________________________

Title:______________________________

Date:______________________________

Page 4: Acceptable Worker’s Compensati

Page | 2

BROKER - CARRIER AGREEMENT

This Agreement is entered into this day of , 20 , by and between Artisan Logistics Inc. ("BROKER"), a Registered Property Broker, Lic. No. MC-136229-B, and

, a Registered Motor Carrier, Permit/Certificate No. DOT- ("CARRIER"); collectively, the "Parties". ("Registered" means operated under authority issued by the Federal Motor Carrier Safety Administration (or its predecessors) within the U.S. Department of Transportation.)

1. CARRIER REPRESENTS AND WARRANTS THAT IT:

A. Is a Registered Motor Carrier of Property authorized to provide transportation of propertyunder contracts with shippers and receivers and/or brokers of general commodities;

B. Shall transport the property, under its own operating authority and subject to the terms of thisAgreement;

C. Makes the representations herein for the purpose of inducing BROKER to enter into thisAgreement;

D. Agrees that a Shipper’s insertion of BROKER’s name as the carrier on a bill of lading shall befor the Shipper’s convenience only and shall not change BROKER’s status as a propertybroker or CARRIER’s status as a motor carrier.

E. Will not re-broker, assign or interline the shipments hereunder, without prior written consent ofBROKER. If CARRIER breaches this provision, BROKER shall have the right of paying themonies it owes CARRIER directly to the delivering carrier, in lieu of payment to CARRIER.Upon BROKER’s payment to delivering carrier, CARRIER shall not be released from anyliability to BROKER under this Agreement. In addition to the indemnity obligation in Par 1.HCARRIER will be liable for consequential damages for violation of this Paragraph.

F. Is in, and shall maintain compliance during the term of this Agreement, with all applicablefederal, state and local laws relating to the provision of its services including, but not limited to:transportation of Hazardous Materials, (including the licensing and training of drivers), asdefined in 49 C.F.R. §172.800, §173, and §397 et seq. to the extent that any shipmentshereunder constitute Hazardous Materials; security regulations; owner/operator leaseregulations; loading and securement of freight regulations; implementation and maintenance ofdriver safety regulations including, but not limited to, hiring, controlled substances, and hoursof service regulations; sanitation, temperature, and contamination requirements fortransporting food, perishable, and other products, qualification and licensing and training ofdrivers; implementation and maintenance of equipment safety regulations; maintenance andcontrol of the means and method of transportation including, but not limited to, performance ofits drivers.

G. CARRIER will notify BROKER immediately if its federal Operating Authority is revoked,suspended or rendered inactive for any reason; and/or if it is sold, or if there is a change incontrol of ownership, and/or any insurance required hereunder is threatened to be or isterminated, cancelled, suspended, or revoked for any reason.

Page 5: Acceptable Worker’s Compensati

Page | 3

H. i. Subject to the express monetary insurance limits in Par 3.D as to CARRIER, andBROKER’S monetary insurance limits for public liability, $1,000,000, and property damage, $1,000,000, or such other amounts as mutually agreed by the Parties in writing, CARRIER shall defend, indemnify and hold BROKER and its shipper customer harmless from any claims, actions or damages, arising out of its performance under this Agreement, including cargo loss and damage, theft, delay, damage to property, and personal injury or death, arising out of its performance hereunder. Neither Party shall be liable to the other for any claims, actions or damages due to the negligence of the other Party, or the shipper. The obligation to defend shall include all costs of defense including attorney fees.

ii. Except for CARRIER’s liability under Par 1.E, unless otherwise agreed in writing, andregardless of whether the Parties insurance as referred to in sub par i) above, is valid orprovides coverage, the Parties indemnity obligations shall not exceed the monetaryinsurance limits referred to in sub par i).

I. Does not have an “Unsatisfactory” safety rating issued by the Federal Motor Carrier SafetyAdministration (FMCSA), U.S. Department of Transportation, and will notify BROKER inwriting immediately if its safety rating is changed to “Unsatisfactory” or “Conditional”.

J. Authorizes BROKER to invoice CARRIER’s freight charges to shipper, consignee, or thirdparties responsible for payment.

K. Has investigated, monitors, and agrees to conduct business hereunder based on the credit-worthiness of BROKER and is granting BROKER credit terms accordingly.

2. BROKER RESPONSIBILITIES:

A. SHIPMENTS, BILLING & RATES: BROKER agrees to solicit and obtain freight transportationbusiness for CARRIER to the mutual benefit of CARRIER and BROKER. BROKER shallinform CARRIER of (a) place of origin and destination of all shipments; and (b) if applicable,any special shipping instructions or special equipment requirements, of which BROKER hasbeen timely notified.

B. BROKER agrees to conduct all billing services to shippers. CARRIER shall invoice BROKERfor its (CARRIER’s) charges, as mutually agreed in writing, contained in BROKER’s LoadConfirmation Sheet(s) incorporated herein by reference (Exhibit A, et seq.). Additional rates fortruckload or LTL shipments, or modifications or amendments of the above rates, or additionalrates, may be established to meet changing market conditions, shipper requirements,BROKER requirements, and/or specific shipping schedules as mutually agreed upon, andshall be confirmed in writing (or by fax) by both Parties. Any such additional, modified, oramended rates, changes in rates shall automatically be incorporated herein by reference aspart of Exhibit A, Amendment 1, et seq.

C. RATES: Additionally, any rates, which may be verbally agreed upon, shall be deemedconfirmed in writing where CARRIER has billed the agreed rate and BROKER has paid it. Allwritten confirmations of rates, including confirmations by billing and payment, shall beincorporated herein by reference as part of Exhibit A, Amendment 1, et seq. Rates or charges,including but not limited to stop-offs, detention, loading or unloading, fuel surcharges, or otheraccessorial charges, released rates or values, or tariff rules or circulars, shall only be validwhen specifically agreed to in a signed writing by the Parties.

Page 6: Acceptable Worker’s Compensati

Page | 4

D. PAYMENT:i. The Parties agree that BROKER is the sole party responsible for payment of CARRIER's

charges. Failure of BROKER to collect payment from its customer shall not exonerateBROKER of its obligation to pay CARRIER. BROKER agrees to pay CARRIER's invoice within30 days of receipt of the bill of lading or proof of delivery, provided CARRIER is not in defaultunder the terms of this Agreement.

ii. Two Day Quick Pay is available for a 3% fee.

iii. Payment and other disputes are subject to the terms of Par 4.D, which provides in part thatprevailing parties are entitled to recovery of costs, expenses and reasonable attorney fees.

DI. BOND: BROKER shall maintain a surety bond /trust fund as agreed to in the amount of$75,000 and on file with the Federal Motor Carrier Safety Administration FMCSA) in the formand amount not less than that required by that agency’s regulations.

DII. BROKER will notify CARRIER immediately if its federal Operating Authority is revoked,suspended or rendered inactive for any reason; and/or if it is sold, or if there is a change incontrol of ownership, and/or any insurance required hereunder is threatened to be or isterminated, cancelled, suspended, or revoked for any reason.

3. CARRIER RESPONSIBILITIES:

A. EQUIPMENT: Subject to its representations and warranties in Paragraph 1 above, CARRIERagrees to provide the necessary equipment and qualified personnel for completion of thetransportation services required for BROKER and/or its customers. CARRIER will not supplyequipment that has been used to transport hazardous wastes, solid or liquid, regardless ofwhether they meet the definition in 40 C.F.R. §261.1 et. seq. CARRIER agrees that allshipments will be transported and delivered with reasonable dispatch, or as otherwise agreed inwriting.

B. BILLS OF LADING: CARRIER shall issue a bill of lading in compliance with 49 U.S.C. §80101 etseq., 49 C.F.R. §373.101 (and any amendments thereto), for the property it receives fortransportation under this Agreement. Unless otherwise agreed in writing, CARRIER shallbecome fully responsible/liable for the freight when it takes/receives possession thereof, and thetrailer(s) is loaded, regardless of whether a bill of lading has been issued, and/or signed, and/ordelivered to CARRIER, and which responsibility/liability shall continue until delivery of theshipment to the consignee and the consignee signs the bill of lading or delivery receipt. Anyterms of the bill of lading (including but not limited to payment terms) inconsistent with the termsof this Agreement shall be controlled by the terms of this Agreement. Failure to issue a bill oflading, or sign a bill of lading acknowledging receipt of the cargo, by CARRIER, shall not affectthe liability of CARRIER.

C. LOSS & DAMAGE CLAIMS:i. CARRIER shall comply with 49 C.F.R. §370.1 et seq. and any amendments and/or any other

applicable regulations adopted by the Federal Motor Carrier Safety administration, U.S.Department of Transportation, or any applicable state regulatory agency, for processing allloss and damage claims and salvage; and

D. CARRIER’s liability for any cargo damage, loss, or theft from any cause shall be determinedunder the Carmack Amendment, 49 U.S.C. §14706; and

E. Special Damages: CARRIERs indemnification liability (Par 1.H) for freight loss and damageclaims under this sub par C (ii) shall include legal fees which shall constitute special damages,the risk of which is expressly assumed by CARRIER, and which shall not be limited by anyliability of CARRIER under sub par (ii) above.

Page 7: Acceptable Worker’s Compensati

Page | 5

iv. Except as provided in Par 1.E above, neither Party shall be liable to the other forconsequential damages without prior written notification of the risk of loss and itsapproximate financial amount, and agreement to assume such responsibility in writing.

v. Notwithstanding the terms of 49 CFR 370.9,CARRIER shall pay, decline or make settlementoffer in writing on all cargo loss or damage claims within 30 days of receipt of the claim.Failure of CARRIER to pay, decline or offer settlement within this 30 day period shall bedeemed admission by CARRIER of full liability for the amount claimed and a material breachof this Agreement.

vi. CARRIER’s liability for cargo damage, loss, or theft from any cause for any one shipment,under sub part ii) above, shall not exceed $100,000 unless CARRIER is notified by BROKERor Shipper of the increased value 7 days prior to shipment pick up.

D. INSURANCE: CARRIER shall furnish BROKER with Certificate(s) of Insurance, naming theBROKER “Additional Insured as their interest appear”, provide thirty (30) days advancewritten notice of cancellation of coverage, and unless otherwise agreed, subject to thefollowing minimum limits: Public liability $1,000,000; motor vehicle (including hired and non-owned vehicles), property damage, and personal injury liability $1,000,000 ($5,000,000 iftransporting hazardous materials including environmental damages due to release ordischarge of hazardous substances); cargo damage/loss, $100,000; workers’ compensationwith limits required by law. Except for the higher coverage limits which may be specifiedabove, the insurance policies shall comply with minimum requirements of the Federal MotorCarrier Safety Administration and any other applicable regulatory state agency. Nothing in thisAgreement shall be construed to avoid CARRIER’s liability due to any exclusion or deductiblein any insurance policy.

E. ASSIGNMENT OF RIGHTS: CARRIER automatically assigns to BROKER all its rights tocollect freight charges from Shipper or any responsible third party on receipt of payment fromBROKER.

4. MISCELLANEOUS:

A. INDEPENDENT CONTRACTOR: It is understood and agreed that the relationship betweenBROKER and CARRIER is that of independent contractor and that no employer/employeerelationship exists, or is intended. BROKER has no control of any kind over CARRIER,including but not limited to routing of freight, and nothing contained herein shall be construedto be inconsistent with this provision.

B. NON-EXCLUSIVE AGREEMENT: CARRIER and BROKER acknowledge and agree that thiscontract does not bind the respective Parties to exclusive services to each other. Either partymay enter into similar agreements with other carriers, brokers, or freight forwarders.

C. WAIVER OF PROVISIONS:i. Failure of either Party to enforce a breach or waiver of any provision or term of this

Agreement shall not be deemed to constitute a waiver of any subsequent failure or breach,and shall not affect or limit the right of either Party to thereafter enforce such a term orprovision.

Page 8: Acceptable Worker’s Compensati

Page | 6

ii. This Agreement is for specified services pursuant to 49 U.S.C. §14101(b). To the extentthat terms and conditions herein are inconsistent with Part (b), Subtitle IV, of Title 49 U.S.C.(ICC Termination Act of 1995), the Parties expressly waive any or all rights and remediesthey may have under the Act.

D. DISPUTES: In the event of a dispute arising out of this Agreement, including but not limited toFederal or State statutory claims, the Party's sole recourse (except as provided below) shall beto arbitration. Proceedings shall be conducted under the rules of the American ArbitrationAssociation (AAA). Arbitration proceedings shall be started within eighteen (18) months fromthe date of delivery or scheduled date of delivery of the freight, whichever is later. Uponagreement of the Parties, arbitration proceedings may be conducted outside of theadministrative control of the AAA. The decision of the arbitrators shall be binding and final andthe award of the arbitrator may be entered as judgment in any court of competent jurisdiction.The prevailing party shall be entitled to recovery of costs, expenses and reasonable attorneyfees as well as those incurred in any action for injunctive relief, or in the event further legalaction is taken to enforce the award of arbitrators. Arbitration proceedings shall be conductedat the office of the AAA nearest Columbia, SC or such other place as mutually agreed upon inwriting or directed by the acting arbitration association. Provided, however, either Party mayapply to a court of competent jurisdiction for injunctive relief. Venue for any such action shallbe in South Carolina. Unless preempted or controlled by federal transportation law andregulations, the laws of the State of South Carolina shall be controlling. The arbitrationprovisions of this paragraph shall not apply to enforcement of the award of arbitration.

E. NO BACK SOLICITATION:i. Unless otherwise agreed in writing, CARRIER shall not knowingly solicit freight shipments

for a period of 12 month(s) following termination of this agreement for any reason, from anyshipper, consignor, consignee, or other customer of BROKER, when such shipments ofshipper customers were first tendered to CARRIER by BROKER.

ii. In the event of breach of this provision, BROKER shall be entitled, for a period of 12 monthsfollowing delivery of the last shipment transported by CARRIER under this Agreement, to acommission of 15 percent (15%) of the gross transportation revenue (as evidenced byfreight bills) received by CARRIER for the transportation of said freight as liquidateddamages. Additionally, BROKER may seek injunctive relief and in the event it is successful,CARRIER shall be liable for all costs and expenses incurred by BROKER, including, but notlimited to, reasonable attorney's fees.

F. CONFIDENTIALITY:i. In addition to Confidential Information protected by law, statutory or otherwise, the Parties

agree that all of their financial information and that of their customers, including but notlimited to freight and brokerage rates, amounts received for brokerage services, amounts offreight charges collected, freight volume requirements, as well as personal customerinformation, customer shipping or other logistics requirements shared or learned betweenthe Parties and their customers, shall be treated as Confidential, and shall not be disclosedor used for any reason without prior written consent.

ii. In the event of violation of this Confidentiality paragraph, the Parties and agree that theremedy at law, including monetary damages, may be inadequate and that the Parties shallbe entitled, in addition to any other remedy they may have, to an injunction restraining theviolating Party from further violation of this Agreement in which case the prevailing Partyshall be liable for all costs and expenses incurred, including but not limited to reasonableattorney’s fees.

Page 9: Acceptable Worker’s Compensati

Page | 7

G. The limitations of liability for cargo loss and damage as well as other liabilities, arising out of thetransportation of shipments, which originate outside the United States of America, may besubject to the laws of the country of origination.

H. MODIFICATION OF AGREEMENT: This Agreement and Exhibit A et. seq. attached may notbe amended, except by mutual written agreement, or the procedures set forth above (Pars 2.Band 2.C).

I. NOTICES:i. All notices provided or required by this Agreement, shall be made in writing and delivered,

return receipt requested, to the addresses shown herein with postage prepaid; or byconfirmed (electronically acknowledged on paper) fax.

ii. THE PARTIES shall promptly notify each other of any claim that is asserted against eitherof them by anyone arising out of the Parties performance of this Agreement.

iii. Notices sent as required hereunder, to the addresses shown in this Agreement shall bedeemed sent to the correct address, unless the Parties are notified in writing of anychanges in address.

J. CONTRACT TERM: The term of this Agreement shall be one year from the date hereof andthereafter it shall automatically be renewed for successive one (1) year periods, unlessterminated, upon thirty (30) day's prior written notice, with or without cause, by either Party atany time, including the initial term. In the event of termination of this Agreement for anyreason, the Parties shall be obligated to complete performance of any work in progress inaccordance with the terms of this Agreement.

K. SEVERANCE: SURVIVAL: In the event any of the terms of this Agreement are determined tobe invalid or unenforceable, no other terms shall be affected and the unaffected terms shallremain valid and enforceable as written. The representations, rights and obligations of theparties hereunder shall survive termination of this Agreement for any reason.

L. COUNTERPARTS: This Agreement may be executed in any number of counterparts each ofwhich shall be deemed to be a duplicate original hereof.

M. FAX CONSENT: The Parties to this Agreement are authorized to fax to each other at thenumbers shown herein, (or otherwise modified in writing from time to time) shipmentavailabilities, equipment and rate promotions, or any advertisements of new services.

N. ENTIRE AGREEMENT: Except for Exhibit A and its amendments, and unless otherwiseagreed in writing, this Agreement contains the entire understanding of the Parties andsupersedes all verbal or written prior agreements, arrangements, and understandings of theParties relating to the subject matter stated herein. The Parties further intend that thisAgreement constitutes the complete and exclusive statement of its terms, and that no extrinsicevidence may be introduced to reform this Agreement in any judicial or arbitration proceedinginvolving this Agreement.

Page 10: Acceptable Worker’s Compensati

Page | 8

IN WITNESS WHEREOF, we have signed this Agreement the date and year first shown above.

BROKER CARRIER

Artisan Logistics Inc. Company Name Company Name

Authorized Signature Authorized Signature

Christopher I. McCroskey Printed Name: Printed Name:

Chief Operations Officer Title Title

Company Address: Company Address:

1 Windsor Cove, Suite 403 Street or P.O. Box Street or P.O. Box

Columbia, SC 29223 City State Zip City State Zip

Country: USA Country:

Phone:

Fax:

Phone: _(803) 712-4931

Fax: _(803) 712-4922

E-Mail: [email protected] E-Mail:

Page 11: Acceptable Worker’s Compensati

Form W-9(Rev. December 2014)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

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2.

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification; check only one of the following seven boxes:

Individual/sole proprietor or single-member LLC

C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶

Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner.

Other (see instructions) ▶

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):Exempt payee code (if any)

Exemption from FATCA reporting

code (if any)(Applies to accounts maintained outside the U.S.)

5 Address (number, street, and apt. or suite no.)

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.

Social security number

– –

orEmployer identification number

Part II CertificationUnder penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal RevenueService (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I amno longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Sign Here

Signature of U.S. person ▶ Date ▶

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9.

Purpose of FormAn individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following:

• Form 1099-INT (interest earned or paid)

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K (merchant card and third party network transactions)

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

• Form 1099-C (canceled debt)

• Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2.

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information.

Cat. No. 10231X Form W-9 (Rev. 12-2014)

Page 12: Acceptable Worker’s Compensati

  ARTISAN LOGISTICS INC. 

GENERAL COMPANY INFORMATION 

Legal Name: Artisan Logistics Inc.          

Physical Address: 1 Windsor Cove Suite 403, Columbia, SC 29223  

Billing Address: 1 Windsor Cove Suite 403, Columbia, SC 29223   

Carrier Set Up: [email protected]         

Billing Contact: [email protected]   

Dispatch Phone Number: 803‐712‐4931 

Carrier Relations Fax: 803‐712‐4922 

Website: www.artisanlogistics.com 

Federal ID #: 83‐1975935 MC #: 136229 Type of Business: 3PL 

Federal Tax Classification: Inc. SCAC: AGST DOT #: 3190848 

D‐U‐N‐S Number: 05‐423‐1904 

CARRIER BILLING REQUIREMENTS 

1. Bill noting ART PRO number sent by email, fax, or mail supported by,

2. Consignee signed BOL/POD (R+L Carriers’ haul must have signed Settlement Pay Sheet)

3. Signed Rate Confirmation

4. Refer to Carrier Contract for complete explanation of billing requirements

TRADE REFERENCES Please ask for point of contact listed below: 

K&T Trucking Express Kevin Smith (President) 404‐910‐9976 

Ivan CookVP, Business Development OfficerBibby Transportation Finance, [email protected]

Single Source Apparel Terry Latham (President) 800‐438‐0620  

Page 13: Acceptable Worker’s Compensati

Data Source: Licensing and Insurance16:17November 14, 2018Run Date:

Run Time: li_carrierPage 1 of 2

Addresses:Business Address:

Business Phone:Mail Address:

Mail Phone:

Business Fax:

Mail Fax: Undeliverable Mail:

1 WINDSOR COVE STE 403

(803) 712-4931

NO

COLUMBIA, SC 29223

NONE NONONE NOACTIVE NOYES NO NO

Common Authority:Contract Authority:Broker Authority:Property:

Application Pending:Application Pending:Application Pending:Passenger: Household Goods:

NO

Authorities:

NO $0 $0NO NO NOYES YES YES

Insurance Requirements:

BIPD Exempt:Cargo Exempt:BOC-3:

BIPD Waiver: BIPD Required:Cargo Required:Bond Required:

BIPD on File:Cargo on File:Bond on File:

EVILSIZOR PROCESS SERVERS LLC

84

HUDSON INSURANCE COMPANY

SURETY10082029 $0 $75,000

10/23/2018

Active/Pending Insurance:

Form: Type:Policy/Surety Number: Coverage From: To:Effective Date: Cancellation Date:

Insurance Carrier:Attn:

Address:

Telephone:

1035 GREENWOOD BLVD, STE:265LAKE MARY, FL 32746 US

Fax:

Comments:

* If a carrier is in compliance, the amount of coverage will always be shown as the required Federal minimum ($5,000 per vehicle, $10,000 per occurrence for cargo insurance, $75,000 for bond/trust fund insurance for brokers and freight forwarders). The carrier may actually have higher levels of coverage.

*

Blanket Company:

Posted Date: 10/23/2018

MC136229Docket Number:3190848 USDOT Number:

Legal Name:

DBA (Doing-Business-As) Name

ARTISAN LOGISTICS INC

FMCSA Motor Carrier

Private: NO Enterprise: NO

Page 14: Acceptable Worker’s Compensati

Data Source: Licensing and Insurance16:17November 14, 2018Run Date:

Run Time: li_carrierPage 2 of 2

Form: Type:Policy/Surety Number: Coverage From: $0 To:Received: Rejected:Rejected Reason:

$0

Rejected Insurances:

Insurance History:

Form:Policy/Surety Number:Effective Date From:

Type:Coverage From To:

Disposition:To: $0 $0

Insurance Carrier:Attn:

Address:

Telephone: Fax:

Authority Type Filed Status Insurance BOC-3Pending Application:

Authority Type 1st Serve Date 2nd Serve Date ReasonRevocation History:

Sub No.

PROPERTY BROKER

Authority Type

GRANTED

Original Action

10/29/2018

Disposition Action

Authority History:

MC136229Docket Number:3190848 USDOT Number:

Legal Name:

DBA (Doing-Business-As) Name

ARTISAN LOGISTICS INC

FMCSA Motor Carrier

Page 15: Acceptable Worker’s Compensati