Certified Statement of Lease

[49 CFR Section 376.11 (c)(2)]

_____________________________ hereby certifies that the equipment

described below is being operated by _______________________________
pursuant to a lease with the owner/lessor named below, as follows:

Make: _________________________________________

Year: __________________________________________

Model: _________________________________________

License #: ________________________ State: __________________

Owner: _________________________________________

VIN #: __________________________________________

Unit #: __________________________________________

Date of Lease: ____________________________________

Length of Lease: Until cancelled by either party or not less than 30 days’
written notice or until terminated pursuant to paragraph (b) on page 1.

There are not restrictions to the Lease relative to the commodities to be

transported (with the exception of HazMat).

The original Lease is kept by ___________________________________ at

____________________________________________________________

_________________________ _________________
Date
 Exhibit “A”

Equipment List

Equipment # Year Make Model Serial # Lic. #

* To be completed by LESSOR and returned to

_______________________ to be included in Master Lease. List all units
under Lease to _____________________________.
 Exhibit “B”

This compensation agreement supersedes all existing compensation

schedules, appendices, and addendum’s, and will be attached to all
equipment leases. Effective _______________________ and thereafter the
rates, fees, and compensation schedule as outlined below will become the
prevailing pay program.

All loads will be paid at $_________/mile, $________/trip, $_________/hr

___________________________, by signature of the addendum, does

hereby consent and agree to the terms and conditions stated above. Likewise
the contractor and owner operator, by signature of this addendum, does here
by consent and agree to the condition stated above.

________________________ _________________________
LESSOR

________________________ _________________________
Date Date
 Exhibit “C”

Receipt for Possession of Equipment

The undersigned hereby acknowledges possession of the equipment

described in Exhibit “A,” Truck VIN # __________________________,
Unit # _________________________ at:
__________________________________________________________
received from ______________________________ this _______________
of __________, 200___ at _____________ o’clock am/pm.

_________________________
 Exhibit “D”

Receipt of Return Equipment

The undersigned ______________________________ (LESSOR) hereby

certified that he/her, as the duly qualified owner or agent of the owner or
person authorized to have possession, has this _________________ day of
______________, 200__ at ______________ o’clock am/pm, received from
_____________________________________, the above described
equipment.

Truck VIN #: ____________________________

Unit #: _________________________________

_____________________________ ____________________
Signature of Duly Authorized Date
Representative of Owner or Person
Entitled to Possession