Burgess Bros USDOT 142628

Total Number of Inspections for the measurement period (24 months)	0
Total Number of Driver Inspections for the measurment period	0
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
Burgess Bros 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

Burgess Bros 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
Burgess Bros 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

Burgess Bros 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
Burgess Bros 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	West Bend Mutual Insurance Co.	0110101951	$0	$750,000	10/04/2011
91X	BIPD/Primary	West Bend Mutual Insurance Co.	0110101951	$0	$1,000,000	08/19/2000	11/03/2011 Cancelled
91X	BIPD/Primary	West Bend Mutual Insurance Co.	0110101951	$0	$1,000,000	08/19/2000	10/04/2011 Replaced
91X	BIPD/Primary	American States Insurance Co.	01BA260854	$0	$750,000	08/19/1988	08/19/2000 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.';

American States Insurance Co. SAFECO PLAZA., P. O. BOX 34754 SEATTLE, WA Fax:(425)376 - 6533

West Bend Mutual Insurance Co. 1900 SOUTH 18TH AVENUE WEST BEND, WI Fax:(608)410 - 3412