customer service - logistics
Logistics | Motor Carrier Survey | PPE Requirements | Insurance Requirements | Contact Us
You have landed on this page because you've selected Hire by Koch and/or Access Koch Facilities from the New Carrier Request form. Please fill out the form and submit it along with the new carrier request form.
Motor Vehicle Accident Rate
OSHA 200/300 Total Recordable Incident Rate
A-1 Please provide FMCSA/HMSP/DOT Authority Numbers (as applicable).
A-2 How many units do you own and lease?
A-3 Have you ever had an on-site DOT Safety Compliance Review?
What is the date of the most recent DOT Compliance Review?
A-4 What is your DOT Motor Carrier Safety Rating?
A-5 Do you have a written safety policy?
A-6 How many millon miles were driven during each of the last three years?
A-7 What was your motor vehicle accident rate during each of the last three years?(For help, see Form Guidance)
A-8 What was your OSHA 200/300 recordable incident rate during each of the last three years?(For help, see Form Guidance) - If not applicable, please indicate why.
A-9 How many spills/releases were reported on DOT Form 5800.1 during each of the last three years?
A-10 Has your company re-organized/shipped under a different company name within the last 5 years?
B-1 List your company's contact for transportation-related emergencies:
B-2 Is a contracted service used by your company for incident response and/or emergency response? (This service may be provided by your insurance company)
B-3 Detail your company's procedure for ensuring notification of our company, in the event of any incident involving our product.
B-4a Are drivers and shipments monitored during transit (tracking system/scheduled communication via phone/etc.)?
B-4b If shipping DOT Hazmat, do you meet the requirements of 49CFR172.802(a)(3) for enroute security?
B-5 If shipping DOT Hazmats, does your driver vetting process meet the requirements of 49 CFR 172.802(a)(1)
B-6) Transportation Security (49 CFR 172.80) (Applicable only to hazardous materials shipments. Others should mark N/A)
C-1) What are your insurance limits on a per occurence basis? Complete the table below indicating your applicable limits.
For each load-specific category, indicate if Driver Training complies with all applicable regulations governing the material hauled and whether Written Procedures are in place that comply with all applicable hazardous materials regulations.
Person responsible for providing the information contained in this survey:
Survey was completed by:
Please email copies of a W9 and a blank invoice to one of the following addresses;
Dry Products: KFDRYTruck@kochind.com
NH3/Liquid Products: KFNH3_LiquidTruck@kochind.com
To receive ACH payments directly to your bank, please complete the following forms and return with your W9 and Blank Invoice.
ACH/EFT Authorization Information
Wire Authorization Information
Thank you for taking the time to fill out the form. A representative will contact you if any further documentation is needed.
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