Washington Utilities And Transportation Commission For The Year Ended December 31, 2007 Annual Report Template (Page 3 of 5) in pdf

Washington Utilities And Transportation Commission For The Year Ended December 31, 2007 Annual Report Template Page 3

CLASS C ANNUAL REPORT

SCHEDULE 1

Washington Unified Business Identifier (UBI) No.:_________________________________________________________

(If you do not know your UBI No. please contact the Department of Licensing at 360-664-1400)

Company Name:___________________________________________________________________________________

d/b/a:____________________________________________________________________________________________

Mailing Address:___________________________________________________________________________________

Physical Address:__________________________________________________________________________________

Telephone Number:_________________________________________________________________________________

E-mail:___________________________________________________________________________________________

Fax Number:______________________________________________________________________________________

Web Address:_____________________________________________________________________________________

US DOT Number:__________________________________________________________________________________

BUSINESS STRUCTURE

Individual

Partnership

Corporation

Other (LP, LLP, LLC, etc.)

List the name, title, and percentage of partner’s shares or stock distribution for major stockholders. If LLC, list members and

percentage of ownership.

Name

Title

Percentage of shares, stock or ownership

ALLOWANCE FOR OWNER’S SERVICES

Show duties performed and estimated annual number of hours devoted to the business for the sole proprietor or for each

member of partnership. Also provide the total allowance for such services if not included in Schedule 2.

Name

Address

Duties Performed

No. of

Allowance

Hours

Amount

ADDITIONAL COMPANY INFORMATION

Safety Contact Person:

Telephone Number:

Operations Contact Person:

Telephone Number:

Customer Service Contact Person:

Telephone Number:

Number of Commercial Motor Vehicles Operated in 2007:

Number of Commercial Motor Vehicle Drivers Employed in 2007:

Total Intrastate Operating Miles in 2007:

Washington Utilities And Transportation Commission For The Year Ended December 31, 2007 Annual Report Template Page 3