Company Profile
MC#: 703352
USDOT# 2246020
Additional Contact Information
Federal ID# 27-0678887
SCAC: TBTO
Mailing Address:
Accounts Payable:
DUNS: 02-055-2769
221 Washington St., Binghamton, NY 13901
Monica Keyser
Hours Of Operation: Monday-Friday 8AM-5PM EST
E-Mail: Billing@ShipTriBros.com
Tel: (607) 296-4528
Monica@ShipTriBros.com
Fax #: (607) 217-4004
Website: www.ShipTriBros.com
Emergency After Hours Contacts:
General Delivery E-Mail Address: Team@ShipTriBros.com
Cristian Simut, President
Insurance
Phone: (607) 242-4875
GSIS Inc.
Policy #: PL3306984 / K14500-117 Phone #: (310) 379-9660
-orE-Mail: 911@ShipTriBros.com
Factoring Company Information
Tri-Bros currently works with Advance Business Capital LLC (aka Triumph Business Capital) as our factoring company.
Please ensure all invoices are directly assigned using the following information. If you have any questions or concerns,
please don’t hesitate to contact our accounting department.
Payment Remittance and Notice Of Assignment
Triumph Business Capital, LLC
P.O. Box 610028, Dallas, TX, 75261-0028
Shipper Questionnaire
Company Name:
Contact Name:
Agent Name:
Telephone Number:
Today’s Date:
Hours Available:
Commodity & Products Shipped:
Equipment Acceptable:
FB
SD
Will EQ Be Specified In Emails/Faxes?
YES
NO Explain:
Is a Tarp Generally Required?
FB/SD
YES
Size Of Tarp Drop?
REEF
VAN
DD
FB/wSides
Other?
NO Will The Distribution List Specify?
4
6
8
Coil Racks?
YES
NO
YES
NO
Any Other Special Equipment Needed?
And How Are These Shipments Rates Set? — Are they….
Based Upon A Rate Quote?
YES NO Will The Distribution List Specify?
Based Upon A Fixed Rate Sheet?
YES
YES NO Other?
REGULAR SHIPPING LOCATIONS & HOURS
Facility 1)
City/State:
Loading Hours:
Facility 2)
City/State:
Loading Hours:
SPECIAL CIRCUMSTANCES
Does Your Company Pay Detention?
YES
NO
After How Many Hours?
COMMENTS & NOTES
Rate?
NO
Shipper Profile
Company Name:
___________________________________
Mailing Address:
___________________________________
__________________________________________________
Contact Information
Physical Address: ___________________________________
__________________________________________________
Shipping Hours: ____________________________________
Toll-Free: _________________________________________
Local Phone: _______________________________________
Fax #: ____________________________________________
Traffic Manager: __________________________
Direct Phone: _____________________________
Direct Fax: _______________________________
Direct E-Mail: _____________________________
Accounting Contact: ________________________
Website: __________________________________________
Direct Phone: _____________________________
Industry / Commodity: _______________________________
Direct Fax: _______________________________
SIC / NAICS (If Known): __________________________________
Direct E-Mail: _____________________________
Hours Of Operation: __________________________________
Address (If Different): ___________________________________________
Site Manager Name:__________________________________
______________________________________________
Site Manager E-mail: _________________________________
Additional Contact: _____________________________
Accounting Preferences
Title: _________________________________________
Phone: _______________________________________
Invoicing Comments: __________________________________
Fax: __________________________________________
__________________________ Net Pay Terms:_____________
Email: ________________________________________
Shipping Data (Most Frequent)
Type Of Product Shipped: _____________________________ Pickup City/States: _______________________________________
Equipment Required: __________________________________ Delivery City/States: ______________________________________
General Dimensions: __________________________________ Other: _________________________________________________
Additional Information: _____________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Shipping Agreement
This Agreement is entered into this _____ day of __________, 201__, to be effective on the date signed, by
and between Tri-Bros Transportation (“Broker”), and ________________________________________,
“Shipper”, located at ________________________________________________________(City & State).
RECITALS:
(A) Broker is authorized to arrange freight by motor carrier as a Property Broker pursuant to the laws and
regulations issued by the U.S. Department of Transportation, and/or the rules and regulations of the
Federal Highway Administration if applicable on interstate commerce.
(B) That at all time for which this Agreement shall be effective, Broker shall comply with said laws and
regulations and otherwise maintain its Broker authorities; and
(C) This agreement shall be effective from the date signed by both the Shipper and the Broker
IT IS AGREED AS FOLLOWS:
(1) The term of this agreement shall commence upon the effective date of this Agreement and continue for a
period of three months at the average marketed rate and that said Agreement will continue in effect as
amended with the consent of the Broker and the Shipper. This Agreement may be terminated upon 30 days
written notice by either party to the other, but in no case prior to thirty (30) days after the effective date of
this agreement.
(2) Broker agrees that it will at all times hold itself ready and able to perform the services thereunder, subject to
the availability and limitations of equipment. Shipper agrees that reasonable notice will be given the Broker
for need of the service. Broker has the right to utilize such motor vehicle equipment, as in its discretion is
necessary to comply with the terms and provisions of this Agreement with reference to the transportation of
the Shipper’s commodities, and to utilize sub-haulers and owner-operators in its discretion to perform the
transportation services herein.
(3) Shipper agrees to pay Tri-Bros Transportation as compensation for such transportation the rates and charges
set forth during the rate confirmation of the shipment, and are further subject to the rules, regulations and
decisions prescribed by the Federal Motor Carrier Safety Administration and the US Department of
Transportation. The parties may, from time to time, modify said rates in writing, also subject to the rules
and regulations.
(4) If either party to this Agreement should suffer damage in any manner due to the negligence of the other
party or the agent thereof, the injured party shall be reimbursed by the negligent party for the actual amount
of damages, up to the amount necessary to replace the damaged goods being transported, as stipulated by the
rules and regulations of the US Department of Transportation and the Federal Motor Carrier Safety
Administration. Except in the case of the Broker’s negligence, Shipper agrees to not hold the Broker
responsible for any consequential damage such as profits, cost of obtaining additional transportation, etc.
Other than due to Shipper’s negligence, Broker shall not be responsible for acts of God, strikes, weather
conditions, inability to secure labor, fire regulations or restrictions imposed by any government or
governmental agency, or other delays beyond the control of the Broker.
(5) Broker shall perform all services thereunder as an independent contractor and shall render freight bills to the
Shipper for payment. Shipper agrees to submit payment for services rendered to Tri-Bros Transportation,
LLC no more than thirty (30) days after presentation of said freight bills.
(6) Neither of the parties shall assign this Agreement or any interest or right herein without the written consent
of the other.
(7) This agreement shall be interpreted under the laws of the state of the Broker.
(8) In the event of any dispute or litigation arising out of or relating to the meaning, interpretation or breach
hereof, or compliance or non-compliance with the terms of this Agreement, the prevailing party shall be
entitled to reasonable attorney’s fees and cost, to be paid by the losing party.
(9) All notices to be delivered or deliverable under this Agreement shall be in writing sent by certified or
registered mail.
IN WITNESS WHEREOF, the parties have signed this Agreement on the day and year above
written.
Broker: Tri-Bros Transportation, LLC DBA Tri-Bros
Connections
Address: 221 Washington St.
Binghamton, NY 13901
By: Cristian Simut / President
Shipper: ________________________________
Address: ________________________________
________________________________
By:
Title:
________________________________
________________________________
TRANSPORTATION
January 1st, 2015
221 Washington St.
Binghamton, NY 13901
Tel: (607) 296-4528
Fax:(607) 217-4004
e-Mail: Mgmt@ShipTriBros.com
To Whom It May Concern:
Tri-Bros Transportation, LLC is a general freight brokerage. Our team has the highest standards of
compliance within the trucking industry to ensure our continuing relationship with all our clientele.
Please see below a brief explanation of minimum standards for any carrier to join our affiliate
network. Should you have any questions, comments or suggestions on how to improve our services,
please do not hesitate to contact our management at anytime. Thank you.
Carrier Compliance Checklist:
1) Proof of Insurance With Tri-Bros Transportation, LLC as Certificate Holder
a) Minimum General Liability Per Occurrence of $1,000,000
b) Minimum General Liability Aggregate of $2,000,000
c) Minimum Auto Liability of $1,000,000 ($5,000,000 if HazMat Certified)
d) Minimum Cargo Insurance of $100,000
e) Proof of Worker's Compensation based upon State Law
2) A fully endowed background check of carrier safety records as provided by SaferSYS.org. This
website is provided as a service through the Department of Transportation.
3) Carrier may not be "black-listed" by any associated organization, had any previous issues with any
of Tri-Bros' clientele, and furthermore not listed on any publicly available "dangerous" blanket list.
Cordially,
The Management of Tri-Bros Trans.
w w w . S h i p T r i B r o s . c o m
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
11/13/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE 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 to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
CONTACT
GSIS CSR
NAME:
PHONE
(310)379-9660
(A/C, No, Ext):
E-MAIL
ADDRESS: lauren@gsis.com
PRODUCER
GSIS Inc.
2613 Manhattan Beach Blvd.
Suite 200
Redondo Beach
CA 90278
FAX
(A/C, No): (310)374-2431
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A :Hiscox
Syn 33
INSURER B :Kiln 510
INSURED
Tri-Bros Transportation LLC, DBA: Tri-Bros
221 Washington St.
112650
INSURER C :
INSURER D :
INSURER E :
Binghamton
NY
13901
INSURER F :
CERTIFICATE NUMBER:Master 15-16
COVERAGES
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE 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.
INSR
LTR
ADDL SUBR
INSD WVD
TYPE OF INSURANCE
X
A
POLICY NUMBER
POLICY EFF
POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
X
$
11/14/2015 11/14/2016 MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
OCCUR
H3315-053
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
GEN'L AGGREGATE LIMIT APPLIES PER:
PROPOLICY
LOC
JECT
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
AUTOMOBILE LIABILITY
B
HIRED AUTOS
X
SCHEDULED
AUTOS
NON-OWNED
AUTOS
K15500-046
$
1,000,000
$
11/14/2015 11/14/2016 BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident)
$
$
Contingent Auto
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
B
B
2,000,000
100,000
10,000
2,000,000
4,000,000
4,000,000
$
OTHER:
ANY AUTO
ALL OWNED
AUTOS
$
$
PER
STATUTE
Y/N
OTHER
E.L. EACH ACCIDENT
N/A
$
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT
Contingent Cargo Legal Liab
Errors and Omissions
K15500-046
11/14/2015 11/14/2016 $100,000 any one acc/occ
K15500-046
11/14/2015 11/14/2016 $100,000 any one acc/occ
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER
CANCELLATION
Tri-Bros Transportation LLC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Jennifer Morgan/SS
ACORD 25 (2014/01)
INS025 (201401)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
U.S. Department of Transportation
Federal Motor Carrier Safety Administration
1200 New Jersey Ave .• S.E.
Washington. DC 20590
SERVICE DATE
May 05, 2010
LICENSE
MC-703352-B
TRI-BROS. TRANSPORTATION, LLC
D/B/A TRI-BROS. CONNECTIONS
ENDICOTT, NY
This License is evidence of the applicant's authority to engage in operations, in interstate or foreign
commerce, as a broker, arranging for transportation of freight (except household goods) by motor
vehicle.
ThiS authority will be effective as long as the broker maintains insurance coverage for the protection of
the public (49 CFR 387) and the designation of agents upon whom process may be served (49 CFR
366). The applicant shall also render reasonably continuous and adequate service to the public. Failure
to maintain compliance will constitute sufficient grounds for revocation of this authority.
Jeffrey L. Secrist, Chief
Information Technology Operations Division
BPO
FORM BMC-85
Revised 09/ 26/ 2013
OMB No.: 2126-0017
Expiration: 01/31/2014
A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current
valid OMB Control Number. The OMB Control Number for this information collection is 2126-0017. Public reporting for this collection of information
is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and
reviewing the collection of in formation . All responses to this collection of information are mandatory. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.
ift\
United States Department of Transportation
\~ Federal Motor Carrier Safety Administration
Broker's or Freight Forwarder's Trust Fund Agreement under 49 U.S.C. 13906
or Notice of Cancellation of the Agreement
FORM BMC-85
Filer FMCSA Account Number:
-=2:. :6:. :0:. =2:. .:7_____
License No. MC- -'7-=0'-=3--=3--=5--=2=------
KNOW ALL MEN BY THESE PRESENTS, that we, TRI-BROS TRANSPORTATION, LLC D/B/A TRI-BROS CONNECTIONS .
(Name of Broker or Freight Forwarder)
of 4700 AMHERST A VENUE
VESTAL
NewYork
13850
(City)
(State)
(Zip)
~~~~~------------
(Street)
as TRUSTOR (hereinafter called Trustor), and TRANSPORT FINANCIAL SERVICES, LLC
(Name of Trustee)
a financial institution created and existing under the laws of the State of ..:F..:l.:.o:..:ri:.:d:.:a:...___________ as TRUSTEE (hereinafter called Trustee)
(State)
hold and firmly bind ourselves and our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these
presents.
WHEREAS, the Trustor is or intends to become either a Broker or a Freight Forwarder pursuant to the provisions of the Title 49 U.S.C.
13904, and the rules and regu lations of the Federal Motor Carrier Safety Administration (FMCSA) relating to insurance or other security
for the protection of motor carriers and shippers, and has elected to file with the Federal Motor Carrier Safety Administration such a Trust
Fund Agreement as will ensure financial responsibility and the supplying of transportation subject to the ICC Termination Act of 1995 in
accordance with contracts, agreements, or arrangements therefor, and
WHEREAS, this Trust Fund Agreement is written to assure compliance by the Trustor as either a licensed Broker or a licensed Freight
Forwarder ofTransportation by motor vehicle with 49 U.S.C 13906(b), and the rules and regulations of the Federal Motor Carrier Safety
Administration, relating to insurance or other security for the protection of motor carriers or shippers, and shall inure to the benefit of
any and all motor carriers or shippers to whom the Trustor may be legally liable for any of the damages herein described.
NOW, THEREFORE, the trustor and trustee, to accomplish the above, agree as follows:
1. Trustee agrees that payments made pursuant to the security provided herein to shippers and motor carriers pursuant to this
Agreement will be made exclusively and directly to shippers or motor carriers that are parties to contracts, agreements or
arrangements with Trustor.
2. Trustee agrees that the protection afforded to shippers and motor carriers hereby will continue until any and all claims made by
shippers or motor carriers for which Trustor may be legally liable have been settled or until the funds deposited by Tru stor pursuant
to this Agreement have been exhausted, whichever comes first.
3. The parties hereto acknowledge and certify that said Trustee shall exclusively manage the security and trust fund, as herein set forth,
and shall have legal title to the security and trust fund, pursuant to the terms and conditions as set forth in this agreement. Further,
the parties hereto, and the said Trustee, as evidenced by their signatures to this agreement, acknowledge and certify that (a) said
Trustee, neither has nor expects to have any interest, financial, proprietary, or otherwise, whatsoever, in Trustor; and (b) said Trustor,
neither has nor expects to have any interest, financial, proprietary, or otherwise, whatsoever, in Trustee.
4. Trustee acknowledges the receipt of the sum of Seventy Five Thousand Dollars ($75,000) for a Broker or Freight Forwarder, to be held
in trust under the terms and conditions set forth herein.
5. Trustee may, within its sole discretion, invest the funds comprising the corpus of this trust fund consistent with its fiduciary
obligation under applicable law.
6. Trustee shall pay, up to a limit of Seventy Five Thousand Dollars ($75,000} for a Broker or Freight Forwarder, directly to a shipper or
motor carrier any sum or sums which Trustee, in good faith, determines that the Trustor has failed to pay and wou ld be held legally
liable by reason ofTrustor's failure to perform faithfully its contracts, agreements, or arrangements for transportation by authorized
motor carriers, made by Trust or while this agreement is in effect, regardless of the financial responsibility or lack thereof, or the
solvency or bankruptcy, ofTrustor.
FORM BMC-85 Page 1 of 2
FORM BMC-85
Revised 09/26/2013
OMB No.: 2126-0017
Expiration: 01/31/2014
7. In the event that the trust fund is drawn upon and the corpus of the trust fund is a sum less than Seventy Five Thousand Dollars
($75,000) Brokers or Freight Forwarders, Trustor shall, within thirty (30) days, replenish the trust fund up to Seventy Five Thousand
Dollars ($75,000) Brokers or Freight Forwarders by paying to the Trustee a sum equal to the difference between the existing corpus
of the trust fund and Seventy Five Thousand Dollars ($75,000) Brokers or Freight Forwarders.
8. Trustee shall immediately give written notice to the FMCSA of all lawsuits filed, judgments rendered, and payments made under this
trust agreement and of any failure by Trustor to replenish the trust fund as required herein.
9. This agreement may be canceled at any time upon thirty (30) days written notice by the Trustee or Trustor to the FMCSA on the
form printed at the bottom of this agreement. The thirty (30) day notice period shall commence upon actual receipt of a copy of the
trust fund agreement with the completed notice of cancellation at the FMCSA's Washington, DC office. The Trustee and/or Trustor
specifically agrees to file such written notice of cancellation.
10. All sums due the Trustee as a result, directly or indirectly, of the administration of the trust fund under this agreement shall be billed
directly to Trustor and in no event shall said sums be paid from the corpus of the trust fund herein established.
11. Trustee shall maintain a record of all financial transactions concerning the Fund, which will be available to Trustor upon request and
reasonable notice and to the FMCSA upon request.
12. This agreement shall be governed by the laws in the State of Florida
and regulations ofthe FMCSA.
, to the extent not inconsistent with the rules
This trust fund agreement is effective the 1st
day of October
2013
, 12:01 a.m., standard time at the
address of the Trustor as stated herein and shall continue in force until terminated as herein provided.
Trustee shall not be liable for payments of any of the damages hereinbefore described which arise as the result of any contracts,
agreements, undertakings, or arrangements made by the Trustor for the supplying of transportation after the cancellation of this
Agreement, as herein provided, but such cancellation shall not affect the liability of the Trustee for the payment of any such damages
arising as the result of contracts, agreements, or arrangements made by the Trustor for the supplying of transportation prior to the date
such cancellation becomes effective.
2013
IN WITNESS WHEREOF, the said Principal and Surety have executed this instrument on the _l_s_t___ day of October
TRUSTOR
TRUSTEE
TRJ-BROS TRANSPORTATION, LLC D/B/A TRl-BROS=
TRANSPORT FINANCIAL SERVICES, LLC
COMPANY NAME
COMPANY NAME
850 W GARDEN STREET SUITE A
4700 AMHERST A VENUE
VESTAL
STREET ADDRESS
CITY
STREET ADDRESS
607-239-5975
Florida
New York
STATE
13850
ZIP CODE
NOTICE OF CANCELLATION
This is to advise that the above Trust Fund Agreement executed on the
850-433-2294
TELEPHONE NUMBER
Only financial institutions as defined under 49 CPR 387.307(c) may qualify
to act as Trustee. Trustee, by the above sig•tature, certifies that it is a financial
institution and has legal authority to assume the obligations of Trustee and
the financial ability to discharge them.
_ _ _ _ day of
is hereby cancelled as
security in compliance with the FMC SA security requirements under 49 U.S. C.
13906(b) and 49 CFR 387.307, effective as of the _ _ _ _ day of
- - - - - - - - - _____ , 12:01 a.m., standard time at the address
of the trustor, provided such date is not less than thirty (30) days after the
actual receipt of this notice by the FMCSA.
Date Signed
32502
ZIP CODE
TELEPHONE NUMBER
PENSACOLA
CITY
Signature of Authorized Representative
of Trustee or Trustor
FORM BMC-85 Page 2 of 2
W-9
Request for Taxpayer
Identification Number and Certification
Fonn
(Rev. August 2013)
Department of the Treasury
Internal Revenue Service
Give Form to the
requester. Do not
send to the IRS.
Name (as shown on your income tax return)
Tri-Bros Transportation, LLC
C'.i
Business name/disregarded entity name, if different from above
Gl
g>
a. Check appropriate box for federal tax classification:
c
0
Gl Ul
0
lndividuaVsole proprietor
0
C Corporation
Exemptions (see instructions):
0
S Corporation
0
Partnership
0
Trust/estate
a. IS
~-=
... IJ
0
2
Exempt payee code (if any)
0
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) .,..
p
'E~
·~ .5
ll.u
;;:::
'()
Cll
Q.
II)
Gl
Gl
Exemption from FATCA reporting
code (if any)
0
Other (see instructions) .,..
Address (number, street, and apt. or suite no.)
Requester's name and address (optional)
4700 Amherst Avenue
City, state, and ZIP code
rn Vestal, NY 13850
List account number(s) here (optional)
.:F-1
~··
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line
.
.
. ..
. .
.
to av01d backup w1thhold1ng. For IndiVIduals, th1s 1s your soc1al secunty 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 chart on page
number to enter.
I Social security number
ITJJ -OJ -1
I
I I I I
4 for guidelines on whose
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or:l 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 Revenue
Service (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 am
no 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 secu~ed
p operty, ca.n ~llation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than inter
nd dividend , you ar , t-·fequired to sign the certification, but you must provide your correct TIN. See the
instructions on page 3.
withholding tax on foreign partners' share of effectively connected income, and
Section references are to the Internal Revenue Code unless otherwise noted.
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
exempt from the FATCA reporting, is correct.
Future developments. The IRS has created a page on IRS.gov for information
about Form W-9, at www.irs.gov/w9. Information about any future developments
affecting Form W-9 (such as legislation enacted after we release it) will be posted
on that page.
·
Note. If you are a U.S. person and a requester gives you a fonn other than Fonn
W-9 to request your TIN, you must use the requester's form if it is substantially
similar to this Form W-9.
Purpose of Form
A person who is required to file an information return with the IRS must obtain your
correct taxpayer identification number (TIN) to report, for example, income paid to
you, payments made to you in settlement of payment card and third party network
transactions, real estate transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or contributions you made
·to an IRA
Use Form W-9 only if you are a U.S. person Qncluding a resident alien), to
provide your correct TIN to the person requesting it (the requester) and, when
applicable, to:
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
Definition of a U.S. person. For federal tax purposes, you are considered a U.S.
person if you are:
o
An individual who is a U.S. citizen or U.S. resident alien,
A partnership, corporation, company, or association created or organized in the
United States or under the laws of the United States,
o
o
An estate (other than a foreign estate), or
o
A domestic trust (as defined in Regulations section 301. 7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in
the United States are generally required to pay a withholding tax under section
1446 on any foreign partners' share of effectively connected taxable income from
such business. Further, in certain cases where a Form W-9 has not been received,
the rules under section 1446 require a partnership to presume that a partner is a
foreign person, and pay the section 1446 withholding tax. Therefore, if you are a
U.S. person that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your U.S. status
and avoid section 1446 withholding on your share of partnership income.
Cat. No. 10231X
Form
W-9 (Rev. 8-2013)
gJADVANCE
BUSINESS CAPITAL
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TRI-BROS. TRANSPORTATION, L.L.C. DBA TRI-BROS. CONNECTIONS has partnered
with Advance Business Capital for the financing, management and collections of company's
accounts receivable and payables. Advance Business Capital is one of the premier financial
service providers to the for-hire trucking market and the leading provider of carrier payment
services for transportation intermediaries. Advance Business Capital assumes full responsibility
for carrier payments, including Quick Payment options, for all factored loads.
FACT SHEET
Legal Name:
Advance Business Capital LLC
Address:
70 I Canyon Drive, Suite 105, Coppell, Texas 75019
Telephone:
(214) 513-9600
Facsimile:
(214) 513-9611
Ownership:
Private Investor Group
Officers:
Steven Hausman - President, George Thorson - Executive Vice
President, Robert Berg - Vice President & Controller
Management Board:
Harold Marshall, Edward Wanandi, Tom Donohue, Michael Starnes,
Rob Estes, David Pasquesi, Rob Lansing Products:
Accounts Receivable and Payable Management Target Market:
For-Hire Carriers, Freight Brokers & 3rd Party Intermediaries Banking:
Frost Bank . Federal ID Nbr:
13-4284814
DUNS Nbr:
16-892-4442 Web Site:
www.advancebcap.com Advance Business Capital is the first and only factoring service to endorse the P3 best practices standards of the Transportation Intermediaries Association.
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