Freight Broker (BMC-84) Bond Claim Form

Federal Motor Carrier Safety Administration (FMCSA BMC-84) Claim Form – Freight Broker/Freight Forwarder Bond

This form is for the submission of a claim on a freight broker/freight forwarder (BMC-84) bond. If you are a shipper or motor carrier and you are owed money by a freight broker/freight forwarder, please complete the following claim form.

Before submitting your claim, please download and/or print Allegheny Casualty Company’s Proof of Claim form linked below. Please be advised that an executed and notarized Proof of Claim form is a required component of your online claim submission. This form must be completed in full by a Corporate Officer or Managing Member of the motor carrier company and must be notarized.

Please be advised that the individual executing the Proof of Claim form will be asked to undergo identity verification as part of our internal procedures to mitigate fraudulent misrepresentation. Claimants will receive an identity verification link sent to their provided email once the claim has been submitted.

Proof of Claim forms executed and signed by factoring company representatives or collections company representatives on behalf of motor carriers will not be accepted. If you are a factoring or collections company representative executing the Proof of Claim form on behalf of your client motor carrier, please have your client motor carrier execute and have notarized the Limited Power of Attorney form linked below to authorize such action. Factoring and/or Assignment Agreements will not be accepted in place of Allegheny Casualty Company’s Limited Power of Attorney form.

Proof of Claim Form
Limited Power of Attorney (BMC-84 Bond Claim)

All fields marked with an asterisk* are required.

Have you communicated with the broker in any way in order to try and resolve this issue?*
Yes. If you have not contacted the broker directly to resolve this issue, please do so before you submit a claim.

Claimants must view and acknowledge having viewed the entire below information and check the box below before proceeding to submit a claim.*

Claim Filing:

To file a claim on a BMC-84 bond, you must submit the following documents to Allegheny Casualty Company ("ACC"):

A complete copy of the original, carrier-signed Rate/Load Confirmation.
A complete copy of the executed Broker- Carrier Agreement.
A complete copy of the Bill of Lading which contains the following information:
- The date and location of load pick up.
- The date and location of the load drop off.
- A description of the commodity hauled.
A copy of the Proof of Delivery, usually a dated signature from the consignee.
A copy of the Invoice for the transportation service and proof the invoice was submitted to the broker for payment.
A copy of the written (email) correspondence between the carrier and the broker.
A completed and notarized Proof of Claim form executed by the bond beneficiary or their attorney-in-fact. You will receive a Proof of Claim form to complete with instructions once your claim is submitted.
Notice of Assignment (if applicable).
Power of Attorney to submit claim if submitting on behalf of a carrier/shipper (if applicable).

A completed and notarized Proof of Claim form must be included with the claim submission. Please be advised that your claim filing is not completed until all the above-listed documents are received.

Broker Notification:

Once a claim is filed, Allegheny Casualty Company ("ACC") will notify the broker of the claim. The broker will be given 30 days to pay/resolve the claim or provide a written dispute. If payment has been made or is pending, ACC will request proof of payment from the broker. If there is a dispute over the invoice, the dispute must be supported with agreed-upon terms in the rate confirmation or the broker-carrier agreement.

Payment of Claims:

If a broker fails to pay/resolve or adequately dispute a claim within 30 days of receipt of notice of the claim from ACC, ACC will commence investigation of the claim and determine if any coverage exemptions apply..

According to 49 USC 13906(6), the surety may only pay a claim if one of three conditions are met:

Subject to review by the surety provider, the broker consents to the payment.
In any case in which the broker does not respond to adequate notice to address the validity of the claim, the surety provider determines that the claim is valid.
Or the claim is not resolved within a reasonable time after a reasonable attempt by the claimant to resolve the claim under clauses (i) and (ii) and the claim is reduced to a judgment against the broker.

Coverage Exclusions:

There are certain instances in which a claim on a freight broker (BMC-84) bond would not be covered. The following is a list of exclusions that apply to claims submitted against a freight broker (BMC-84) bond.

The claim is not covered if it is for an intrastate load that was transported entirely within the boundaries of a single state. A load must have been transported interstate or across a state or federal border, to fall under the authority of the FMCSA.
The claim is not covered if it is for a load carrying exempt commodities. Exempt commodities are not regulated by the FMCSA and include any unprocessed, agricultural, and/or perishable cargo. For a comprehensive list of commodities that are considered exempt, please visit: Composite Commodity List (dot.gov).
The claim is not covered if it is for a load that was contracted for transportation by the freight broker outside the effective period of the BMC-84 bond. Any loads contracted prior to the bond's effective date or after the bond's effective cancellation date would not be covered under the bond. Please visit Licensing & Insurance Home Page (dot.gov) to confirm your claim falls within the effective period of the ACC’s BMC-48 bond.
The claim is not covered if the person/entity submitting the claim is not a licensed motor carrier or shipper of goods. The only parties that can benefit from the protections afforded by the BMC-84 bond are licensed motor carriers and shippers of goods i.e., beneficiaries. Any third parties submitting claims on a beneficiary's behalf must have been given proper power of attorney and authority by the beneficiary to file a claim on the beneficiary's behalf.
The claim is not covered if filed after the 60-day period for submission of claims has expired if the bond was cancelled due to financial insolvency. Please visit Freight Broker Bond Cancellation List - Allegheny Casualty Company for a list of bonds that have been cancelled for financial insolvency and applicable claim deadlines.

Broker Insolvency

If the broker is unresponsive to ACC's communications regarding the claim, ACC will investigate the broker for suspected financial insolvency. If determined insolvent, notice of the broker's insolvency will be published on our website here: Freight Broker Bond Cancellation List - Allegheny Casualty Company, in accordance with 49 USC 13906. Once the surety determines the broker is insolvent, the bond is subject to the provisions of 49 USC 13906(6).

According to 49 USC 13906(6):

If a broker registered under this chapter experiences financial failure or insolvency, the surety provider of the broker shall

submit a notice to cancel the financial security to the Administrator in accordance with paragraph (4);
publicly advertise for claims for 60 days beginning on the date of publication by the Secretary of the notice to cancel the financial security; and
pay, not later than 30 days after the expiration of the 60-day period for submission of claims
1. all uncontested claims received during such period; or
2. a pro rata shares of such claims if the total number of such claims exceeds the financial security available.

The FMCSA requires licensed freight brokers to maintain a surety bond (BMC-84) or trust fund agreement (BMC-85) of $75,000.00. If the monetary value of valid claims filed on the bond during the 60-day period exceeds $75,000.00, then each claimant will receive a pro-rated amount for the claim that is proportional to the amount of their original claim submission.

Please be advised ACC will not be able to process your claim for payment under the “Broker Insolvency” provisions of 49 USC 13906(6) if you do not submit all the required documents before the end of the 60-day claim period.

By selecting the box, I acknowledge that I have read, understood, and agree to the disclosures provided above.*

Claimant Information

The company/person filing the claim is considered the "Claimant." The contact information below should be that of the Claimant. The provided information will be used to contact you regarding the claim.

Contact first name*
Contact last name*

Company name*

Address*

City*
State/Territory*
ZIP*

Email*
Phone number*

Your carrier's MC#

An MC# (Motor Carrier #) is given to companies required to have Interstate Operating Authority in addition to a DOT #. All companies that transport federally regulated commodities owned by others or arranging for their transport, (for a fee or other compensation, in interstate commerce) are required to have one. The MC number begins with the letters MC followed by a space and 5 numbers.

Your carrier's USDOT number

Broker Information

The company/person responsible for arranging the transportation and for issuing payment upon completion of the work or service provided is the "broker." The provided information should be that of the Broker.

Company name*

Broker first name*
Broker last name*

Address*

City*
State/Territory*
ZIP*

Email
Phone number

Freight broker USDOT number
The MC# of the freight broker

Bond no.* (All bond numbers must start with ACC)

To find 'Bond Number', please click on this link Licensing & Insurance Carrier Search (dot.gov).
Fill in the 'USDOT Number' or 'MC Docket Number' of the broker you want to file against and click Search.
Click on the 'HTML' button.
View either active/pending insurance (if the bond is active and has not been effectively cancelled) or insurance history (if the bond is inactive and has been effectively cancelled).
Find the Policy number for the bond issued by Allegheny Casualty Company.

Claim Information

Load no.*
Date load was confirmed under contract*

Shipment departure date*
Shipment arrival date*

Shipped from city*
Shipped from state/territory*

Delivered to city*
Delivered to state/territory*

Invoice no.*
Amount Owed*
Payment due date*

Description of Commodity Hauled*

Please identify the product(s) hauled by the motor carrier during transportation.

Description of Claim*

Please provide as much information as possible.

Upload the following documentation

Rate confirmation (8MB max)*

The rate confirmation sheet governs the services and payment issuance between the freight broker and motor carrier. The original, carrier-signed rate confirmation is required to submit a claim on a freight broker/freight forwarder (BMC-84) bond.

Executed broker/carrier agreement (8MB max)*

The executed broker/carrier agreement, oftentimes included in the carrier setup packet, is the contract between the broker and the carrier. This agreement is different than the Rate Confirmation.

Bill of lading (BOL) (8MB max)*

A bill of lading is a legal document, issued by a carrier or a consignor, that details the type, quantity, origin, and destination of the goods being transported.

Proof of delivery (POD) (8MB max)*

A proof of delivery is a signed and dated confirmation by or from the consignee that the goods listed in the bill of lading were delivered

Invoice (8MB max)*

The invoice outlines the cost for the service provided.

Demand/correspondence (8MB max)*

Copies of all written communication between the motor carrier and freight broker regarding this matter.

Proof of Claim form (8MB max)*

The Proof of Claim form is an affidavit in which a Corporate Officer or Managing Member of the motor carrier company affirms the facts of the claim. This form must be executed in full and notarized. If you are a representative of a factoring/collections company submitting the Proof of Claim form on behalf of your client motor carrier, you must also submit an executed Limited Power of Attorney. See below for more information.

Limited Power of Attorney (8MB max)

The Limited Power of Attorney (BMC-84 Bond Claim) is a legal document which grants a third-party representative the authority to file a freight broker bond claim on behalf of the motor carrier (i.e. the beneficiary of the BMC-84). This form must be executed in full and notarized by a Corporate Officer or Managing Member of the motor carrier. Only submit this form if you are a third-party representative submitting this claim on behalf of a client motor carrier.

Notice of Assignment (8MB max)

The Notice of Assignment is a document that assigns specific rights of the carrier (i.e. rights to payment of accounts receivable) to a third-party representative such as a factoring or collections company.

Acknowledgments

Please acknowledge the following claim requirements before submitting your claim to ACC.

This claim is for an interstate load that was part of a continuous movement that crossed a state or federal border during transportation. An interstate load is defined by the FMCSA as any load transported:

Between a place in a State and a place outside of such State (including a place outside of the United States);

Between two places in a State through another State or a place outside of the United States; or

Between two places in a State as part of trade, traffic, or transportation originating or terminating outside the State or the United States.

This claim does not involve the transportation of any exempt (unregulated) commodities as defined under 49 U.S. Code §13506(a)(6).*

This claim is for a load that was arranged by the broker during the period that the freight broker’s/forwarder’s bond with ACC was in effect. You can confirm the effective dates of ACC’s bond by visiting the FMCSA Safer website here.*

The 60-day claim period for this bond has not expired (if applicable). Please visit Allegheny Casualty Company’s FBB Cancellation List to confirm if the bond you are filing a claim against is subject to a 60-day claim period.*

I confirm that I have included all the requested documents for my claim submission including the Rate Confirmation, Broker-Carrier Agreement, Bill of Lading, Proof of Delivery, Invoice, Demand/Correspondence, Proof of Claim, Power of Attorney (if applicable), and Notice of Assignment (if applicable). I further acknowledge that my claim submission will be rejected, and I will be directed to re-submit this claim form if I fail to submit any of the requested documents.*

I acknowledge that identity verification is a requirement component of my Claim submission and I further acknowledge that my claim may be rejected or denied if identity verification is not subsequently completed. I confirm my understanding that I will receive an identity verification link to my provided email after the claim has been submitted and agree to complete identity verification at my earliest opportunity.

Fraud Warnings:

The knowing improper alteration of an insurance claim document is fraud and any submission with such alterations will be reported to the proper regulatory authorities.
For your protection, California law requires the following to appear on this form: Any person who knowingly present a false or fraudulent claim to obtain or amend insurance coverage or to make a claim for payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Contact information for Freight Broker (BMC-84) Bond claim related matters:

Email: [email protected]
Phone Number: (973) 200-6497
Fax Number: (973) 339-5834
Mailing Address: 1 Baxter Way, Suite 130, Westlake Village, CA 91362
Attn: James Portman, Chief Legal Officer

Please have the following available:

Claimant Information (contact name, company (claimant) name, address, email, phone, carrier no.)

Principal Information (principal company name, principal address, USDOT number, MC no., bond no. (if known), invoice no., payment due date, amount owed, whether a demand been made on the principal or not)

Documentation (rate confirmation, executed broker/carrier agreement, bill of lading (BOL), proof of delivery (POD), invoice, demand/correspondence

Freight Broker Bonds Cancellations List

Delivering the Future of Surety

Freight Broker (BMC-84) Bond Claim Form