“New Carrier Information” Page

W-9

Liability, Cargo and Worker's Comp Certificates of Insurance

Exxact Express, Inc as certificate holder

Notice of cancellation or change

Authority Documentation containing MC Number

Signed Exxact Express, Inc. Carrier - Broker Agreement

Factoring company information for payment (if applicable)q

Telephone 800-443-3798 • 863-682-4101 • Fax 863-688-7660

New Carrier Packet Checklist

Below is a list of the documents required by Exxact Express, Inc. to be set up as a carrier:

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P. O. Box 95545 • Lakeland, FL 33804-5545

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DATE OF AGREEMENT:

48' 53'

48' 53'

State:

Equipment

Dispatcher:SCAC Code:

North West

NOTES

***THIS FORM MUST BE COMPLETED***

New Carrier Information

800-443-3798 FAX: 863-688-7660

Telephone 800-443-3798 • 863-682-4101 • Fax 863-688-7660

P. O. Box 95545 • Lakeland, FL 33804-5545

NOHazmat Endorsed: YES

South West

Preferred States:

North East

Phone Number:

E-mail:

Fax Number:

Reefers:

Mid West

Dry Vans:

City:

Tractors:

Central

Areas Serviced

South East

Carrier

Zip:

Name:

Address: Phone 800 Number:

4.  The CARRIER shall be liable for all loss, damage, or liability occasioned by transportation of property arranged

by the BROKER while being transported by the CARRIER.

1. The term of this Agreement shall be perpetual, provided however, that either Party may terminate the same

upon 30 days written notice. If, however, the CARRIER institutes termination, CARRIER agrees it will not directly or

indirectly solicit any BROKER accounts which were tendered to the CARRIER by the BROKER beyond the date of

cancellation. As liquidated damages upon violation of this clause, CARRIER agrees to pay back a 15% commission on

all traffic handled for customers introduced to CARRIER by BROKER for a period of 18 months following the

termination of this Agreement.

WHEREAS, the CARRIER is a Motor Carrier operating in interstate commerce, Pursuant to operating authority issued

to it by the Interstate Commerce Commission;

NOW THEREFORE, in consideration of the mutual covenants and promises hereinafter set forth, the parties agree as

follows:

EXXACT EXPRESS, INC.

CARRIER - BROKER AGREEMENT

This agreement is entered into between EXXACT EXPRESS, INC., a licensed I.C.C. Property Broker, MC 200412,

herein after referred to as BROKER _____________________________________, whose

address is ________________________________________________, herein

after referred to as CARRIER.

Under no circumstances will CARRIER invoice the customer/shipper/consignee, or solicit payment from them in any

form.

2.  The CARRIER agrees to transport goods for mutually agreed rates, negotiated on a per load basis by both

parties.

5.  The CARRIER shall uphold the good reputation of the BROKER and shall not misrepresent the services and

abilities of the BROKER.

WHEREAS, the BROKER is a licensed Property Broker and engaged in the business of negotiating and conducting the

transportation of regulated commodities in interstate commerce over public highways; and

CARRIER warrants to BROKER that it meets the following criteria: (a) CARRIER shall maintain all risk cargo insurance

in the amount of not less than $100,000 per shipment; (b) CARRIER shall maintain public liability insurance in the

amount of not less than $1,000,000 as required by federal regulation; (c) CARRIER shall maintain worker's

compensation as required by state law; (d) CARRIER shall be in compliance with all applicable laws.

3.  The CARRIER agrees to transport such goods on its equipment and will not broker, interline, co-broker, assign

or trip lease freight under this agreement. In no event will BROKER or its customer(s) be held liable for freight payment

to sub-contracted carriers due to violation of this clause.

BROKER shall be named as a "Certificate Holder" on the policies. CARRIER will not cancel or change coverage of the

insurance without giving BROKER written notice. CARRIER will be liable to BROKER for any and all damages resulting

from CARRIER'S failure to maintain required insurance.

6. The CARRIER shall invoice BROKER for freight charges due. CARRIER shall submit freight charges, along

with all original paperwork, to: EXXACT EXPRESS, INC., P.O. Box 95545, Lakeland, FL 33804-5545

Detention: $ 25 / hour, 2 hours free

Unloading: Match original lumper receipt as provided

Layover: $ 100 / day, $ 100 max

Truck Ordered - Not Used: $ 100 / occurrence : Applicable only if notified < 24 hrs. before pickup

EXXACT EXPRESS, INC. CARRIER:

BY: BY:

Authorized Representative Authorized Representative

9. The BROKER shall pay accessorial charges based on the following schedule if notified within 1 hour of

occurrence. Failure to do so will result in non-payment of accessorial charges.

7.  The CARRIER driver is required to call BROKER on a daily basis while under a load and must call to confirm

pickup and delivery. Failure to do so will result in a $50 fine.

8. Advance CARRIER payment is subject to a fee equal to the greater of 10% of the advance amount or $25.

BROKER will deduct fee from invoice payment.

Telephone 800-443-3798 • 863-682-4101 • Fax 863-688-7660

P. O. Box 95545 • Lakeland, FL 33804-5545

Exxact Express, Inc., is a 48 state contract carrier and licensed broker, incorporated in Lakeland, Florida.

MC NUMBER:

FEI NUMBER:

DUNS NUMBER:

McGriff Transportation, Inc. Rosedale Transport, Inc. Baylor Trucking, Inc.

P.O. Box 1148 P.O Box 3427 5114 N. State Road 101

Cullman, AL 35056 Dalton, GA 30719 Milan, IN 47031

Attn: Jake Ext. 501 Telephone #: 706-226-1003 Telephone #: 800-457-9752

Telephone #: 800-950-9034 Fax #: 706-279-1697 Fax #: 812-623-2026

Fax #: 256-737-1835

Mercantile Bank, N.A.

13577 Feather Sound Dr.

Clearwater, FL 33762

Attn: Patrick McManus

Telephone #: 727-561-4109

Fax #: 727-561-4130

INSURANCE CONTACTS

LIABILITY INSURANCE: Reynolds & Reynolds of FL

800-773-5560

CARGO INSURANCE: U.S. Insurance Group of FL

800-808-6865

WORKERS COMPENSATION: Liberty Mutual Insurance Co.

800-282-6218

BANK REFERENCE

Telephone 800-443-3798 • 863-682-4101 • Fax 863-688-7660

P. O. Box 95545 • Lakeland, FL 33804-5545

59-2898424

200412

CARRIER REFERENCES

17-447-6267

SERVICE DATE

PM-25

(Rev. 10/84)

(SEAL) NORETA R. McGEE,

Secretary

If there are any discrepancies regarding this document, please notify the Commission within 30 days.

By the Commission.

This License is evidence of the applicant’s authority to engage in operations as a broker.

LAKELAND, FL

The service to be performed is described on the reverse side of this document.

EXXACT EXPRESS

This authority is subject to any terms, conditions, and limitations as are now, or will be, attached to

this privilege.

December 1, 1987

INTERSTATE COMMERCE COMMISSION

LICENSE

No. MC 200412

This authority will be effective as long as the broker maintains compliance with the requirements

pertaining to insurance coverage for the protection of the public (49 CFR 1043) and the designation of agents

upon whom process may be served (49 CFR 1044). Applicant shall render reasonably continuous and

adequate service under this authority. Failure to meet these conditions will constitute sufficient grounds for

the suspension, change or revocation of this authority.

NOTE:

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCETHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).

CONTACTPRODUCER NAME:FAXPHONE(A/C, No):(A/C, No, Ext):

E-MAILADDRESS:PRODUCERCUSTOMER ID #:

INSURER(S) AFFORDING COVERAGE NAIC #INSURED INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

ADDL SUBRINSR POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY) (MM/DD/YYYY)INSR WVD

GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED

COMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurrence)

CLAIMS-MADE OCCUR MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $PRO- $POLICY LOCJECT

COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident)ANY AUTO

BODILY INJURY (Per person) $ALL OWNED AUTOS

BODILY INJURY (Per accident) $SCHEDULED AUTOS PROPERTY DAMAGE $(Per accident)HIRED AUTOS

$NON-OWNED AUTOS

$

UMBRELLA LIAB EACH OCCURRENCE $OCCUREXCESS LIAB CLAIMS-MADE AGGREGATE $

$DEDUCTIBLE

$RETENTION $WC STATU- OTH-WORKERS COMPENSATION

TORY LIMITS ERAND EMPLOYERS' LIABILITY Y / NANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $

N / AOFFICER/MEMBER EXCLUDED?(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

© 1988-2009 ACORD CORPORATION. All rights reserved.The ACORD name and logo are registered marks of ACORDACORD 25 (2009/09)

OP ID: JW

11/16/11

863-294-4241GIS/Green Insurance Services 1500 6th Street NW Winter Haven, FL 33881

863-294-4243

EXXAC-1

Exxact Express, Inc. Post Office Box 95545 Lakeland, FL 33804

Auto Owners Insurance Co 18988

A Broker Surety Bond 66255337 09/15/11 09/15/12 Bond 10,000

INSURED

Insured