Sam Forrest & Sons USDOT 561430

Total Number of Inspections for the measurement period (24 months)	1
Total Number of Driver Inspections for the measurment period	1
Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation	0
Total Number of Vehicle Inspections for the measurement period	0
Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation	0
Sam Forrest & Sons Unsafe Truck Driving Data
Number of inspections with at least one Unsafe Driving BASIC violation	0
Unsafe Driving BASIC Roadside Performance Measure Value	0
Unsafe Driving BASIC Acute/Critical Indicator (Yes = Acute/Critical from investigation within previous 12 months)	No

Sam Forrest & Sons Hours-of-Service (HOS) Data
Number of inspections with at least one Hours-of-Service BASIC violation	0
Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value	0
Hours-of-Service (HOS) Compliance BASIC Acute/Critical Indicator (Yes = Acute/Critical from investigation within previous 12 months)	No
Sam Forrest & Sons Truck Driver Fitness Data
Number of inspections with at least one Truck Driver Fitness BASIC violation	0
Truck Driver Fitness BASIC Roadside Performance measure value	0
Truck Driver Fitness BASIC Serious Violation Indicator (Yes = Acute/Critical from investigation within previous 12 months)	No

Sam Forrest & Sons Controlled Substances and Alcohol Data
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation	0
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation	0
Controlled Substances and Alcohol BASIC Acute/Critical Indicator (Yes = Acute/Critical from investigation within previous 12 months)	No
Sam Forrest & Sons Vehicle Maintenance Data
Number of inspections with at least one Vehicle Maintenance BASIC violation	0
Vehicle Maintenance BASIC Roadside Performance measure value	0
Vehicle Maintenance BASIC Acute/Critical Indicator (Yes = Acute/Critical from investigation within previous 12 months)	No

Insurance Form	Insurance Type	Insurance Carrier	Policy/Surety	Coverage Amount From	Coverage Amount To	Effective Date From	Effective Date To
91X	BIPD/Primary	Northland Insurance Company	WN157254	$0	$750,000	10/13/2014
91X	BIPD/Primary	Grange Insurance Company Of Michigan	XA 2009007	$0	$750,000	01/01/2013	10/13/2014 Replaced
91X	BIPD/Primary	Great West Casualty Co.	GWP74692A	$0	$1,000,000	01/01/2010	01/01/2013 Cancelled
91X	BIPD/Primary	Progressive Michigan Insurance Company	CA 6119832	$0	$1,000,000	12/21/2007	02/02/2010 Cancelled
91X	BIPD/Primary	Progressive Michigan Insurance Company	CA 6119832	$0	$1,000,000	12/21/2007	01/01/2010 Replaced
91X	BIPD/Primary	Great West Casualty Co.	CLP78959H	$0	$1,000,000	03/28/2005	01/22/2008 Cancelled
91X	BIPD/Primary	Great West Casualty Co.	CLP78959H	$0	$1,000,000	03/28/2005	12/21/2007 Replaced
91X	BIPD/Primary	Amerisure Mutual Insurance Company	CA1241761	$0	$750,000	01/21/1996	02/22/1997 Cancelled
91X	BIPD/Primary	United Southern Assurance Co.	DB16996	$0	$750,000	10/07/1994	01/21/1996 Replaced

* If a carrier is in compliance, the amount of coverage will always be shown as the required Federal minimum ($5,000 per vehicle, $10,000 per occurrence for cargo insurance and $75,000 for bond/trust fund). The carrier may actually have higher levels of coverage.';

Great West Casualty Co. 1100 WEST 29TH ST., P.O. BOX 277 SOUTH SIOUX CITY, NE Fax:(402)494 - 7400	Northland Insurance Company 385 WASHINGTON STREET MAIL CODE 103 ST. PAUL, MN Fax:(651)310 - 4949	Amerisure Mutual Insurance Company 26777 HALSTED ROAD, P.O. BOX 9201 FARMINGTON HILLS, MI Fax:(248)426 - 7796
United Southern Assurance Co. 100 RIALTO PLACE,PO BOX 2648 MELBOURNE, FL	Progressive Michigan Insurance Company P.O. BOX 94739 CLEVELAND, OH Fax:(444)603 - 4555	Grange Insurance Company Of Michigan 650 S. FRONT STREET COLUMBUS, OH