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ATTENTION CARRIER!
PLEASE FAX THIS COMPLETED FORM ALONG WITH THE FOLLOWING DOCUMENTS TO
315-622-5281
• Signed Breakaway Transport Broker/Carrier Agreement
• Workman’s Compensation letter
• Copy of Company Profile (this sheet)
• Copy of Common Carrier Authority (must match insurance certificate)
• Completed W-9 Form
• Insurance Certificate showing Breakaway Transport as the certificate holder
� $1,000,000 General Liability required
� $100,000 Cargo Liability required
YOUR COMPANY PROFILE
Carrier Name:
Federal ID#: MC# DOT#
Receive our Rate Confirmations/Paperwork via Email!
Email:
Email:
Our Company Profile
Remit to Address Credit References
Breakaway Transport MC# 685354 Damar Transportation
PO Box 267 FED ID# 26-4531220 Contact: Megan
Massena, NY 13662 Allentown, PA 18103
PH 315-705-0050 PH 800-573-2670
FX 315-622-5281
Bennett Distribution
Bond Information 1st Security Financial Corp Contact: Ray
3929 Noe-Bixby Road Utica, NY 13504
Columbus, OH 43232 315-725-7250
Physical Address Remit to Address (if different)
Address: Address:
City: City:
State: ZIP State: Zip
Contact:
Phone: Phone:
Fax: Fax:
Contract Carrier Agreement
This Agreement is made this date of , 20 , by and between MC# a
Federal Motor Carrier Safety Administration (FMCSA) licensed and registered motor carrier (CARRIER) and Breakaway Transport LLC 7854 Oswego
Road, Liverpool, NY 13090 (BREAKAWAY).
1. Breakaway is a freight broker authorized by the FMCSA, holding license NO 685354, to arrange for the transportation of property by
motor carrier on behalf of shippers, and for the purposes of contract carriage sufficiently controls the arrangement of transportation of
the commodities to be tendered to Carrier under this Agreement.
2. Breakaway agrees to pay Carrier for the transportation of freight moved under this Agreement in accordance with the rates set forth in
writing in the Rate Conformation Breakaway provides to Carrier at the time of load tender which is made a part hereof. Modifications or
additions to these rates may be agreed to in writing or verbally agreed rates will be made by a recap, faxed or mailed by Breakaway to
Carrier and by the Carrier’s pick up of the shipment. In addition, confirmation of any verbally agreed rates shall be made by the Carrier’s
billing and Breakaway payment thereof. If Breakaway pays the freight invoice in a reduced amount, such amount shall constitute the
agreed rate, unless Carrier indicates to the contract to Breakaway with in sixty (60) days of its receipt of payment. All modifications and
additions to the rates made either in writing or verbally and confirmed in writing or by fax, or as established by the billing and payment
by the Parties together with the underlying freight bills, shall be deemed as appendices to and considered a part of this Agreement.
3. Carrier warrants that it is authorized to operate as a motor carrier by the FMCSA and agrees to provide and maintain, as its sole expense,
primary insurance against liability for injuries to or death of persons and damage to property, in a combined single limit of not less than
1,000,000 per occurrence ( or such greater amount as may be required by United States Federal law for any of the commodities being
transported within the scope of the Services), and for loss of or damage to freight, in an amount not less than $100,000 or greater if the
value of the shipment exceeds that amount; Workers’ compensation coverage on all Carrier employees as required under applicable
State law and any additional insurance required by applicable laws, rules and regulations. Carrier shall furnish Breakaway with
certificates from the insurers evidencing the above required coverages and containing and endorsement adding Breakaway to the Auto
and General Liability policies listed on the certificate as an additional insured and adding Breakaway to the listed Cargo endorsement
providing for not less than thirty (30) days’ advance written notice to Breakaway of cancellation or non-renewal of coverage. Coverage
provide by all policies shall be primary coverage. Carrier shall provide Breakaway a current certificate upon renewal or revision of any
insurance policy required herein.
4. All Services by Carrier shall be rendered as contract carriage within the meaning of 49 U.S.C. SS 13102(4) (B) and 14101(b). In connection
with contract carriage Services, Breakaway and Carrier hereby expressly waive all provisions of Chapters 137 and 147 and any other
provisions of Subtitle IV, Part B of Title 49, United States Code, to the extent that such provisions are in conflict with express provisions of
this Agreement. The Parties do not, however, waive the provisions of the subtitle relation to registration, insurance, or safety fitness.
5. Carrier shall render all Services in a competent, safe and professional manner, and in accordance with all applicable federal, state and
local laws and regulations of the jurisdiction(s) within which the Services are rendered, including but not limited to those laws and
regulations governing the qualification of drivers, the maintenance of the equipment used by the carrier to transport shipments tendered
to it under the terms of this Agreement, and the regulations governing the handling and transport of hazardous materials ( including call
required permits, registration and licenses). Carrier also represents and warrants that its current FMCSA safety rating, if one has been
assigned to it, is not less than “Satisfactory.” Carrier shall give subsequent notice to Breakaway concerning any change in its FMCSA
safety rating or registrations no later than two (2) business days after the effective date of the change.
6. As between Breakaway and Carrier, all cost of rendering the Services (including compensation of subcontractors as well as payment of all
taxes or other governmental assessments imposed on Carrier) shall be borne solely and exclusively by Carrier.
7. Carrier shall not subcontract any Services to third parties without giving prior notice to Breakaway’s prior written consent. Any such
subcontracting, with or without notice and consent, shall not affect Carrier’s responsibilities or liabilities to Breakaway under this
Agreement. Should Carrier violate this provision it shall forfeit its freight to compensation for such shipments, but shall retain all
responsibilities and liabilities to Breakaway under this Agreement with respect to shipments tendered to it.
8. Carrier herby assumes the liability of a motor carrier as provided in 49 U.S.C> 14706 as in effect on the effective date of this Agreement.
All claims for loss and damage and salvage shall be handled and processed in accordance with the regulations of the FMCSA as published
in the Code of Federal Regulations (49 C.F.R. 370) without regard to the limitations of the Part’s application to common carriers. Further,
without regard to the provisions of Part 370 Carrier shall pay, decline or make settlement offer in writing on all cargo loss or damage
claims within thirty (30) days of receipt of the claim. Failure of Carrier to decline or make settlement offer in writing on all cargo loss
or damage claims within 30 days of receipt of the claim shall constitute an admission of liability by the Carrier for the full amount of
the claim and such failure may be submitted as evidence of such liability in any court of competent jurisdiction by either Breakaway or
Shipper. The terms of this Agreement shall govern the relationship between the Parties and their respective liabilities and
responsibilities; the terms, conditions, or provisions of any bill of lading, tariff, or other shipping document utilized by the Carrier or
shipper shall be subject to and subordinate to the terms of this Agreement. The bill of loading or other document issued to evidence
receipt of goods by Carrier shall show Breakaway as the bill-to party for freight charges, shall not show Breakaway as the shipper,
consignee or motor carrier, and shall not show any entity other than Carrier as the motor carrier issuing the Receipt or other instrument.
9. Carrier agrees to hold Breakaway harmless from and indemnify Breakaway for any liability resulting from loss or damage to any freight
transported by Carrier pursuant to this Agreement, including all costs to defend claims. Carrier also agrees to hold Breakaway harmless
from and indemnify Breakaway for any liability resulting from personal injury or property damage, which may occur during the operations
of Carrier pursuant to this Agreement, including all cost to defend claims.
10. Carrier will bill all charges for transportation services directly and exclusively to Breakaway within one hundred and twenty (120) days of
shipment tender date and Carrier shall provide Breakaway with the bill of lading signed by the shipper and receiver, delivery receipt, and
receipts for any applicable accessorial charges. Carrier will cancel all transportation charges due on shipments that are not billed within
this one hundred (120) day period as noted by the postmark date. Breakaway agrees that it will endeavor to pay all freight bills for
transportation performed within thirty (30) days of receipt of the documentation specified herein.
11. Carrier agrees to not directly or indirectly solicit freight from shippers or consignees that it hauled for as a result of the efforts of
Breakaway under this agreement for a period of one (1) year after termination of this agreement. Should Carrier breach this provision, it
is understood between the parties that damages to Breakaway would be difficult to calculate. Therefore, the parties have stipulated and
agreed that should Carrier breach this provision, the sum of ten thousand dollars ($10,000) shall be paid by the Carrier to Breakaway
upon demand.
12. The relationship of Carrier to Breakaway is that of an independent contractor. By this Agreement the Parties do not intend to provide for
division of profits between Carrier, and Breakaway or to cloth Breakaway nor shall Breakaway be liable for any wages, fees, payroll taxes,
assessments or other expenses relating to employees or agents of Carrier. Except that Breakaway shall be agent for Carrier for the
collection and payment of charges to Carrier. The Carrier authorizes Breakaway to invoice the consignor or consignee for freight charges
on behalf of the Carrier and the Carrier agrees that Breakaway is solely responsible for payment of all freight charges to the Carrier.
Carrier will have no claim to in part or whole to Breakaway’s commissions earned on any freight shipments tendered nor shall Breakaway
be required to disclose to Carrier the amount of its commissions earned.
13. The provisions of this Agreement shall be binding upon and inure directly to the benefit of the Parties hereto and the consignor and
consignee of all shipments transported hereunder and may be independently asserted and enforced by them.
14. Obligations of this Agreement are separate and divisible and in the event that any clause is deemed unenforceable, the balance of the
Agreement shall continue in full force and effect. This Agreement shall be binding on, and shall inure to the benefit of, both Parties as
well as their respective successors and permitted assigns. Assignment of this Agreement by either Party requires prior notice to and
consent by the other Party. Neither Party shall unreasonably withhold consent for an assignment by the other Party to an Affiliate of the
assigning Party, provided that the Affiliate first agrees in writing to comply with all terms and conditions of this Agreement.
15. Except to the extent that Federal preemption applies by reason of 49 U.S.C ss 14501 (c) or other law, this Agreement shall be interpreted
in accordance with the laws of the State of New York, disregarding any choice-of-law principle under which that State would look to the
laws of another jurisdiction. The Parties agree that exclusive venue of any lawsuit arising under this Agreement shall be in the
appropriate state or federal court in Onondaga County, New York.
16. This Agreement shall be deemed to be effective on the first date that Carrier and Breakaway commenced business together and the
Parties agree that the provisions contained herein properly express and memorialize the complete understanding of the Parties. No prior
understandings or agreements of the Parties, whether written or oral, nor any documents not specifically incorporated into this
Agreement, nor any course of conduct of the Parties before or after the Effective Date of this Agreement, shall have the effect of
modifying the Parties’ right and obligations under this Agreement in any way. No amendment to this Agreement shall be effective as a
continuing agreement subject to the right of either Party hereto cancel the Agreement at any time upon not less than thirty (30) days
written notice of one Party to the other
CARRIER: ____________________ BREAKAWAY TRANSPORT LLC
BY: ___________________________ BY:
TITLE:___________________________ TITLE: __ PRESIDENT ___
DATE: ___________________________
WORKERS COMPENSATION
HOLD HARMLESS LETTER
_____________________ agrees to hold harmless and indemnify Breakaway Transport LLC. And any of its
affiliates against any award by a worker’s compensation court, similar administrative body, or court of law
_________________________________
Signature of Officer
_________________________________
Title
_________________________________
Date