Form BMC-32 Endorsement for Household Goods Motor Carrier Policies o

FORM BMC-32

OMB No.: 2126-0017 Expiration: 02/28/2017

Revised 02/28/2016

USDOT Number:

Date Received:

A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current
valid OMB Control Number. The OMB Control Number for this information collection is 2126-0017. Public reporting for this collection of information
is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and
reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate
or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.

United States Department of Transportation
Federal Motor Carrier Safety Administration

Endorsement for Household Goods Motor Carrier Policies of Insurance
for Cargo Liability under U.S.C. 13906

FORM BMC-32
Issued to
of
Dated at
this

(Name of Motor Carrier)
(Motor Carrier Street)

(City)

(State)

(Zip)

(Insurance Company Street)

(City)

(State)

(Zip)

31st
30th
29th
28th
27th
26th
25th
24th
23rd
22nd
21st
20th
19th
18th
17th
16th
15th
14th
13th
12th
11th
10th
9th
8th
7th
6th
5th
4th
3rd
2nd
1st

day of

,

December
November
October
September
August
July
June
May
April
March
February
January

Amending Policy Number

2023
2022
2021
2020
2019
2018
2017
2016
2015
Effective Date

Name of Insurance Company
Insurance Company Filer Number

Telephone Number (

)
(Insurance Company)

Countersigned by
(Authorized Company Representative)

Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs.

(continued on next page)
FORM BMC-32 Page 1 of 2

FORM BMC-32

OMB No.: 2126-0017 Expiration: 02/28/2017

Revised 02/28/2016

The policy to which this endorsement is attached is a cargo insurance policy, and is hereby amended to assure compliance by the insured, as a
common carrier of property by motor vehicle, with Section 13906, Title 49 of the United States Code, with reference to making compensation
to shippers or consignees for all property belonging to shippers or consignees coming into the possession of such carrier in connection with
its transportation service under certificate issued to the insured by the Federal Motor Carrier Safety Administration (FMCSA), or otherwise in
transportation in interstate or foreign commerce subject to FMCSA rules and regulations.
In consideration of the premium stated in the policy to which this endorsement is attached, the Company hereby agrees to pay within the
limits of liability hereinafter provided, any shipper or consignee for all loss of or damage to all property belonging to such shipper or consignee,
and coming into the possession of the insured in connection with such transportation service, for which loss or damage the insured may be
held legally liable, regardless of whether or not the motor vehicles, terminals, warehouses, and other facilities used in connection with the
transportation of the property hereby insured are specifically described in the policy. The liability of the Company extends to such losses or
damages whether occurring on the route or in the territory authorized to be served by the insured or elsewhere.
Within the limits of liability hereinafter provided, it is further understood and agreed that no condition, provision, stipulation, or limitation
contained in the policy, or any other endorsement thereon or violation thereof, or of this endorsement by the insured, shall affect in any way the
right of any shipper or consignee, or relieve the Company from liability for the payment of any claim arising out of such transportation service
for which the insured may be held legally liable to compensate shippers or consignees, irrespective of the financial responsibility or lack thereof
or insolvency or bankruptcy of the insured. However, all terms, conditions, and limitations in the policy to which this endorsement is attached
are to remain in full force and effect as binding between the insured and the Company. The insured agrees to reimburse the Company for any
payment made by the Company on account of any loss or damage involving a breach of the terms of the policy and for any payment that the
Company would not have been obligated to make under the provisions of the policy, except for the agreement contained in this endorsement.
The liability of the Company for the limits provided in this endorsement shall be a continuing one notwithstanding any recovery hereunder. The
Company shall not be liable for an amount in excess of $5,000 in respect to all losses or damages to property hereby insured carried on any one
motor vehicle, nor in any event for an amount in excess of $10,000, in respect to any loss of or damage to or aggregate of losses or damages of or
to such property occurring at any one time and place.
Whenever requested by the FM CSA, the Company agrees to furnish to the FMCSA a duplicate original of said policy and all endorsements
thereon. This endorsement may not be canceled without cancellation of the policy to which it is attached. Such cancellation may be effected by
the Company or the insured giving thirty (30) days notice in writing to the FMCSA at its office in Washington, D.C., said thirty (30) days notice to
commence to run from the date notice is actually received at the office of said FMCSA.

FORM BMC-32 Page 2 of 2