Subhauler Application Step 1 of 3 33% SUBHAULER APPLICATIONPlease read through it carefully. Please sign and fill in the appropriate blank spaces. You will also find a W-9 form that you need to fill out. You must provide all information requested in order to process your payment correctly! **Please be advised that you will not receive any payments until we receive the contract back in the office. Also, You need to provide VPT with a CURRENT insurance certificate. You will find the insurance requirements within this contract. Your insurance carrier can fax it directly to our office. Please have them fax it to (909) 947-7751. If you have any questions please call the office at (909) 947-3999. Office hours are from 8:00 a.m. to 5:00 p.m.Today's Date* Date Format: MM slash DD slash YYYY Referred By*Please Select*Sub HaulerOwner OperatorCONTRACT REQUIRMENTSIn order for VPT Inc, to maintain the required file information and work in continued support of your efforts, it is necessary for you to complete and supply the information below: 1. Current CA Drivers License 2. CA Permit 3. Insurance Coverage 4. Sub haul / O.O Contract 5. W-9 Form 6. Drug Policy/Program Certification 7. Workman's Compensation 8. Annual DOT Inspection 9. Medical Card 10. CARB Certification 11. FMCSA Safer Company Snapshot INSURANCE REQUIRMENTSAll insurance companies must be admitted carriers and therefore a party to the California Insurance Guarantee Association. We do not accept carriers that are not licensed to do business in the state of California. All certificates of insurance are subject to approval by VPT Inc. and must meet the insurance regulations of the U.S. D.O.T. (49 CFR 387.11) Further; we need your insurance agency to furnish certificates for the following: We must have the original on file. Certificate of Auto Liability naming VPT as additionally insured and having a ten (10) day notice of cancellation. Minimum is 1 Million combined. Certificate of Cargo Insurance: Freight: $100,000 min for tankers and reefers. Fruit: $25,000 min for all other equipment. Pistachios: $50,000 min Certificate of Physical Damage Coverage on undescribed non-owned trailers/containers: Freight: $50,000 min for tankers, reefers, and end dumps. Fruit: $25,000 min for all other equipment. COMPANY DETAILSCompany NameCurrent Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Cell*Fax*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Number of Trucks*Number of Drivers*DOT Number*MC Number*Commodity Hauling*Please Select One*Owner/OperatorSubhauler with employeesCorporationPartnershipValid Driver’s License No.*State Issued* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Expires On* Date Format: MM slash DD slash YYYY Employer I.D. # or Social Security #*Insurance Company Name* REQUIRED FORMS & DOCUMENTSIf you would prefer to email the required documents listed below please send to hr@vptrucking.comCurrent CA Drivers LicenseCA PermitInsurance CoverageSubhaul / O.O. ContractW-9Drug Policy/Program CertificateWorkman's CompensationAnnual DOT InspectionMedical CardCARB CertificationFMCSA Safer Company Snapshot
