<p> Certified Statement of Lease [49 CFR Section 376.11 (c)(2)]</p><p>______hereby certifies that the equipment described below is being operated by ______pursuant to a lease with the owner/lessor named below, as follows:</p><p>Make: ______</p><p>Year: ______</p><p>Model: ______</p><p>License #: ______State: ______</p><p>Owner: ______</p><p>VIN #: ______</p><p>Unit #: ______</p><p>Date of Lease: ______</p><p>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.</p><p>There are not restrictions to the Lease relative to the commodities to be transported (with the exception of HazMat). </p><p>The original Lease is kept by ______at ______</p><p>______Date Exhibit “A”</p><p>Equipment List </p><p>Equipment # Year Make Model Serial # Lic. #</p><p>* To be completed by LESSOR and returned to ______to be included in Master Lease. List all units under Lease to ______. Exhibit “B”</p><p>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. </p><p>All loads will be paid at $______/mile, $______/trip, $______/hr</p><p>______, 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. </p><p>______LESSOR</p><p>______Date Date Exhibit “C”</p><p>Receipt for Possession of Equipment</p><p>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.</p><p>______Exhibit “D”</p><p>Receipt of Return Equipment</p><p>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.</p><p>Truck VIN #: ______</p><p>Unit #: ______</p><p>______Signature of Duly Authorized Date Representative of Owner or Person Entitled to Possession</p>