Broker Carrier Agreement Broker Carrier Agreement CARRIER PROFILE SHEET All fields must be completed to avoid delays on your paymentCompany Name* Physical Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Same as Mailing Address?* Yes No Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Secondary PhoneFaxEmail* 24 Hour Contact Name* First Last 24 Hour Contact Phone #*MC#* EIN#* DOT#* BROKER-CARRIER AGREEMENT This contract is made this Date* MM slash DD slash YYYY , between Name* (hereinafter referred to as Carrier) having Contract Authority under MC- MC#* and Federal ID of ID#* , and MILLENNIUM BROKERAGE FIRM, INC., (hereinafter referred to as Broker), under ICC-MC 512925, whose principal office is at 370 Six Flags Parkway, Mableton, GA 30126.1. BROKER agrees to offer for shipment and CARRIER agrees to transport with its own equipment at least 200,000 pounds annually or a series of shipments and such additional quantities of freight as BROKER may tender subject to the availability of suitable equipment. 2. CARRIER shall be authorized to operate as a contract motor carrier by the ICC and shall provide and maintain, at its sole cost and expense, insurance against liability for injuries to or death of persons and damage to property, in combined single limits of not less than $1,000,000.00 per occurrence, and for loss of or damage to freight, in an amount not less than $100,000.00, and any additional insurance required by applicable laws, rules and regulations. CARRIER shall furnish upon BROKER request, a copy of each such insurance policy, and written certificates of insurance. 3. CARRIER shall be paid the freight charges of the transportation service to be rendered pursuant to this at the rates set forth in Schedule A, Rate and Load Confirmation. BROKER shall send Schedule A to CARRIER via facsimile or e-mail to confirm Rate and Load Confirmation. All signatures and transactions done via facsimile or e-email are deemed legal and binding. All modifications and additions to the rates made either in writing, or verbally and confirmed in writing, or as established by the billing and payment by the parties together with the underlying freight bills shall be deemed appendices to and considered a part of the rate agreement. All requests by the CARRIER for any additional payment will be allowed only if the CARRIER receives written confirmation from the BROKER for said charges. 4. CARRIER is subject to a $200 in the event the CARRIER fails to pick up the loads and/or fails to deliver on agreed date and time. 5. The parties understand and agree that CARRIER is a contract motor carrier in interstate commerce, and is not obliged by law to file with any government agency its schedule or rates nor to adhere to any schedule filed with any government agency. 6. The Rate and Load Confirmation shall designate the procedures for billing freight charges. 7. CARRIER, upon reasonable demand, shall deliver to BROKER copies of its ICC Operating Authority and Certificate of Insurance, insuring Carriers liability for personal injury, property damage and loss of damage to cargo. Upon request of BROKER, CARRIER shall have its' insurance amended to include insurance of BROKER as its interest may appear. 8. CARRIER, at its sole cost and expense, shall furnish all equipment required for its services hereunder and shall maintain all equipment in good repair and condition. CARRIER, at its sole cost and expense, shall employ for its services hereunder only competent and legally licensed personnel. Without the prior written consent of BROKER, CARRIER shall not cause or permit any shipment tendered hereunder to be transported by any other motor carrier or in substituted service by railroad or other modes of transportation. 9. CARRIER will be responsible to comply with all applicable ICC and DOT Regulations as well as all other federal and state regulations pertaining to the operations of motor carrier. 10. CARRIER shall be liable for loss, damage, or delay of any shipment, and may face possible monetary charges for shipments not delivering as scheduled, while in the possession or control of CARRIER. All claims for loss and damage and salvage shall be handled and processed in accordance with regulations of the ICC as published in the Code of Federal Regulations. 11. Carrier shall issue a Bill of Lading in its own name and will bill all charges for transportation services directly to the Broker and, together with the bill, shall provide Broker with a copy of the signed Bill of Lading and Delivery Receipt. 12. Carrier agrees to hold Broker harmless from and indemnify Broker for any and all personal injury, property damage, loss, claim, injury obligation or liability arising from Carrier's actions, behavior or transportation pursuant to this agreement, and to hold Broker's client harmless for all personal injury, property damage, loss, claim, injury obligation or liability arising from Carrier's actions, behavior or transportation pursuant to this agreement. 13. Carrier agrees that Broker's compensation hereunder for its services is confidential and need not be disclosed by Carrier. Carrier further agrees that it will not reveal to anyone the terms of the agreement, the pricing of transportation services, or any other detail of the business conducted between Carrier and Broker. 14. CARRIER agrees to hold BROKER harmless from and indemnify BROKER from any liability resulting from the loss or damage to any freight transported by CARRIER, and also agrees to hold BROKER harmless from personal injury or property damage which may occur during the operations of CARRIER pursuant to this agreement including all cost to defend claims. 15. CARRIER shall assume full responsibility for all State and Federal taxes and assessments arising out of the transportation herein required of contract motor carrier. 16. It is the intention of the parties that CARRIER shall be an independent contractor for all parties involved in the transportation including BROKER. 17. CARRIER agrees that under no circumstances will it communicate directly with clients referred to it by the BROKER. It is understood by the CARRIER that the provisions of this paragraph pertain to "BACK SOLICITING." The Carrier hereby agrees that neither it nor anyone under its control, will approach those clients introduced to it by the BROKER for the purpose of selling its services directly OR accepting traffic from the client without BROKERS participation. It is agreed by the CARRIER that if such an event occurs the CARRIER will pay the BROKER a commission of 15% on all traffic obtained as a result of BACK SOLICITATION. Said 15% commission is to continue during the period in which this agreement remains in force, and for one year after the termination of the agreement by either party. 18. 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. 19. This contract is binding upon the parties hereto, their successors and assigns, and shall be construed under the laws of the State of Georgia; signatory has authority to bind the corporation of company. 20. This agreement shall continue in full force and effect until either party gives the other thirty (30) days prior notice of termination by certified mail.Carrier* By* Title* W9 FormMax. file size: 10 MB.MC PermitMax. file size: 10 MB.Certificate of InsuranceMax. file size: 10 MB.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
