Bureau of Worker's Compensation Certificate - this is needed if you have more than one driver. If you have more than one truck, but are the only driver please note that on your truck list. When it renews, you will need to forward a new certificate to remain in compliance & receive payment. If you are not required by the State of Ohio to carry coverage, the Waiver must be completed.
Trucking Agreement -
Page #1 fill in your company name and the date
Page #2 under "Contractor": Signature on the by line, printed name of the person signing the Agreement, title on its line (owner, president, ...), date agreement is signed
Insurance Certificate & Endorsements - The requirements are listed on page 1, paragraph 4. The Shelly Company & its affiliates must be named additional insured. Blanket/automatic status is not accepted. See the Requirements sheet for a breakdown of limits and endorsements required. Provide this along with the sample certificate to your insurance agent.
Truck List - Complete for all trucks. If this form is incomplete/incorrect, payments will be affected. If a truck is added, dropped, or changed (ex license plate number), you will need to resubmit this form. If you do not have a company truck number or Kokosing number, you may leave those fields blank. You only need one Shelly number per truck, regardless of material hauled or locations.
W-9 -Remember to sign & date. Any changes to this form from previous year (other than address) will result in a new vendor number being issued.
Contractor Qualification Checklist - Complete & return with any supplemental paperwork required.
Direct Deposit/EFT- Return the enclosed forms to napvendorrequests@na.crh.com. It is not returned with the rest of your packet. Please note, an email address is required -haul sheets will be emailed, checks will be deposited on the same day as the normal check run.
In order to receive a check, this information needs to be filled out completely & kept up to date. If you are not in compliance, you will not receive payment. Some divisions require additional paperwork that is submitted directly to them - it is not part of this packet.
If you have questions, please reach out to:
Charlene Johnson - 740-666-5841 | charlene.johnson@shellyco.com
or shellysoutherndispatch@OMATS.onmicrosoft.com
8328 Watkins Rd Ostrander, OH 43061
Please check your ticket before leaving the plant. If you have not received your check by the Thursday of the week after the last date you hauled, please contact the location you hauled from or the job foreman to see if the ticket has been processed. If further assistance is needed, contact Accounts Payable (AP) at 740-246-6315. If you have Direct Deposit issues, contact Accounts Payable (same number). If you have compliance issues, please contact Charlene at 740-666-5841.