2017 Trucking Driving Championship Quick Facts

Transcription

1 2017 Trucking Driving Championship Quick Facts Date: June 17, 2017 Start time: Registration begins at 9:00 a.m. Location: Winjean Trucking Company, 183 Airport Road, Buckhannon. Directions to Winjean Trucking: Exit 99 off I-79. Take RT33 east 10.5 miles to stop light (Jenkins Ford on right and WV Department of Highways on left). Turn right onto Brushy Fork Rd. Drive 1.1 miles and after passing the Armory, turn right onto Airport Road 7/7. Go 568 feet and turn left at the Winjean Trucking sign. It is approximately 110 miles from Charleston and will take approximately one hour and 45 minutes. Drivers: Complete the enclosed participant form and an Entry & Release form for each driver. Return all forms along with an MVR for each driver by May 8 th, Entry fees are $160 per driver and will be billed once we receive your registrations. Lunch: WVTA provides lunch for all drivers and volunteers. Lunches are available for spectators for $10 each and include hamburgers, chips and a drink. If you would like to order lunch for spectators, complete the lunch order form. Also, spectators can bring their own lunch if they wish. Dinner: The Awards Dinner will be held shortly after the competition. We will be having steaks, potato salad, baked beans, rolls and a drink. Tickets are $40 each. Complete awards dinner order form. TDC and Safety Awards will be presented. Spectators: We have lots of space, so please bring your awnings, coolers, chairs and lot of sunblock. There is also lots of space for the kids to play! Overnight Accommodations: We have rooms blocked at the Hampton Inn, located at 1 Commerce Blvd., for both Friday, June 16th and Saturday, June 17th. The room rate is $109, which includes breakfast. If you would like to make a reservation, please call When making your reservation, please ask for one of the rooms under the WV Trucking Association. The room block will be released on June 12th, so make sure you get your reservations early.

2 Annual Truck Driving Championships June 17, 2017 Please use this form to advise us of the number of drivers you will be entering and list their names. This advance information is necessary in determining the amount of equipment and space that will be required. Entry fees are $160 per driver. We plan to enter drivers in the 2017 WVTA Truck Driving Championships. Are you a member of the American Trucking Associations? Yes No Have you ever had a driver participate in a National Truck Driving Championship? Yes No Number in each class: Straight Truck 3-Axle Tractor Semi-trailer 4-Axle Tractor Semi-trailer Driver Name Rookie? Yes No Driver Name Rookie? Yes No Driver Name Rookie? Yes No 5-Axle Tractor Semi-trailer (van) Driver Name Rookie? Yes No 5-Axle Tractor Semi-trailer (tank) Driver Name Rookie? Yes No 5-Axle Tractor Semi-trailer (flatbed) Driver Name Rookie? Yes No 5-Axle Tractor Semi-trailer (sleeper) Driver Name Rookie? Yes No Twin Trailers Step Van Driver Name Rookie? Yes No Driver Name Rookie? Yes No If more space is needed for additional driver names, please list on separate sheet and include above information. Name Title Company Name and Division Mailing Address City State Zip Telephone Fax Return to: WVTA RETURN NO LATER THAN MAY 8, 2017 If invoice for entry fee and banquet tickets should mailed to different address, list below: Company Contact Address City State Zip Phone Please note all information including driver and class, must be in our office no later than 5/8/17 to be entered into the Truck Driving Championship.

3 2017 Truck Driving Championships & Step Van Driving Championships Entry and Release Form (Be sure to complete Driver Information Sheet on reverse side) Contestant s Name: Preferred Nickname: Competition State: Hosting State Assn.: Employer: Class of Competition (check one) Straight Truck (Single 2-axle vehicle) 3-Axle Tractor-Semitrailer (2-axle tractor & 1-axle 28 semitrailer) 4-Axle Tractor-Semitrailer (2-axle tractor & 2-axle 53 semitrailer) 5-Axle Tractor-Semitrailer (3-axle tractor & 2-axle 53 semitrailer) 5-Axle Sleeper Berth Tractor-Semitrailer (3-axle sleeper tractor & 2-axle 53 semitrailer) Tank Truck (3-axle tractor & 2-axle tank semitrailer) Flatbed (3-axle tractor & 2 axle flatbed semitrailer) Twin Trailers (2-axle tractor & set of 28 semitrailers) Step Van (Step or Package Van) CERTIFICATION BY EMPLOYER. I hereby certify that I am aware of the provisions of Chapter V, Truck Driving Championships Eligibility Rules, of the ATA Truck Driving Championships Rules and Procedures, State and National and applicable appendixes including the Step Van Driving Championships rule summary; that the contestant named herein is eligible to compete under these rules; that the contestant s employer is a member of an ATA-affiliated State Trucking Association, and that all information furnished about them is true to the best of my knowledge and belief. Employer Mgr. s Signature (NOT driver s): Mgr. Title: AGREEMENTS AND RELEASE In consideration of my being permitted to participate in the ATA s National and/or its affiliates Truck Driving Championships (TDC) or Step Van Driving Championships (SVDC) and be eligible for awards offered to participants, I hereby stipulate and agree to the following: 1. I acknowledge that I am not in the employ of ATA or a State Trucking Association. 2. Both as to myself and my heirs and personal representatives, I release ATA, its directors, employees, agents and/or any of its affiliates and the State Association noted above, its directors, employees, agents and/or any of its affiliates from any and all liability and any right of action that may arise from any damage or injury which I may receive while attending or participating in said State or National TDC or National SVDC. 3. I grant the State Association noted above and ATA and its designated agencies exclusive right to make use of information about myself and of photographs supplied with this entry form, along with photographs subsequently taken under ATA s direction, in publicity and advertising activities. I further agree to make myself available for publicity enterprises arranged by ATA, with newspaper and magazine writers and radio and television personnel. 4. I grant State Association noted above and ATA the right to exam my CDL and MVR for the purposes of determining my eligibility to compete at both the State and National TDC or SVDC. 5. I will be bound by all orders, rules and regulations governing ATA s National and/or its affiliates TDC or SVDC while participating in said competitions. CERTIFICATION BY CONTESTANT. I certify that during the 12 months prior to the 2017 TDC: 1. I have been continuously employed as a truck or step van driver by my present employer [exception: 11 of 12 months if previous employer went out of business and all other eligibility requirements are met]; and 2. I have driven and performed the regular duties of a truck driver or step van driver for at least 11 of the 12 months, and that my regular duties of a truck driver or step van driver constituted not less than 60% of my work hours and at least 1200 hours annually. 3. I have not been involved in a fleet motor vehicle or motor carrier vehicle accident in the course of such employment. 4. I have the proper class Commercial Driver s License (if a SVDC applicant, not required), plus required endorsement(s) for the class of competition indicated above. 5. That I hold a CDL from or have been occupationally domiciled in the state of. Occupational domiciled means the terminal, garage or other operating base from which the driver normally and usually works and/or is supervised. 6. That the class of competition I am entering in 2017 is not a class in which I won at the state or regional TDC and/or competed at the National TDC in 2015 and 2016 or 2014 and 2015; or if I am entering the step van class, I did not win the state or regional TDC and/or compete at the National SVDC in the step van class in 2015 and I understand that after winning two consecutive years at the State TDC and/or competing two consecutive years at the Nationals in that same class of competition, I am not eligible to compete in that same class for one year if a step van competitor and two years if a competitor in any other class. 7. I further certify that I have not received any form of pay, bonus, prize or other consideration for time spent in practice as set forth in the ATA Truck Driving Championships Rules and Procedures, State and National. 8. I agree that if I compete and win the State TDC, that I will compete at the National TDC or SVDC (as applicable), unless disqualified or am detained due to a medical emergency, in which case I will notify the applicable State Trucking Association immediately. 9. I acknowledge that any misstatement made with respect to my eligibility for the TDC or SVDC competition may result in the forfeiture of my right to compete or in my disqualification from said competition. Driver s Signature: Attach a photocopy of your MVR showing: 1) Your name and/or signature; and 2) Class of CDL (or License if SVDC applicant) Also attach a copy of your CDL. Form TR-1 American Trucking Associations (Rev. 12/16)

4 2017 ATA Truck Driving Championships & Step Van Driving Championships Driver Information Form Contestant s Name: Home Address: (first) (middle) (last) (number-street) (city) (state) (zip) Class of Competition: Home Phone: ( ) Cell Phone: ( ) Competition State: Employer: Married: Yes No Spouse s Name: Employer Main Office Address: Children s name(s)/age(s): (number-street) (city) (state) (zip) Will significant other attend the State TDC? Yes No National TDC? Yes No Important: Company President: List unusual experiences, aid to motorists or at accident scene, acts of heroism: (first) (middle) (last) Safety Director: (full name) ( ) Awards received: Safety Dir. Address: (number-street) (city) (state) (zip) Hobbies: Terminal Manager: Strangest cargo ever hauled: (full name) ( ) Do you volunteer? Where/how: Termin. Mgr Phone #: ( ) T-shirt size? Jacket Size? Contestant s How many times have you participated in a State TDC? Home Terminal: How many times have you participated in a National TDC or SVDC? (number-street) (city) (state) (zip) Below and above Info is used at Nationals to determine ND Professional Excellence Award eligibility. Length of Service Length of Service Previous State/National TDC or SVDC in which you competed or volunteered: with Present Employer: in Trucking Industry: Year State Competed Class Competed Rank Volunteer Role Number of Years with No-Accident Record: Lifetime Safe Driving Miles: Number of Accidents: Preventable: Non-Preventable: Date of Last Accident: Usual Run: Local Peddle Line-haul Is your company a member of the State Trucking Association? Yes State: No (Please attached separate history sheet if additional space is needed for above listing) Have you ever been a member of America s Road Team? Yes Years: No Have you been on the state Road Team? Yes Years: No Are you interested in serving on America s Road Team? Yes No Have you been on a company Road Team? Yes Years: No For State and National publicity purposes include: Recent 2 X 3 (or larger) head and shoulder photograph (may be ed as instructed by State Championships Committee or hosting State Trucking Association), and The name of your hometown newspaper: and the nearest large city to your hometown: Information sheet must be complete to be eligible for National competition! Form TR-2 - American Trucking Associations (Rev. 12/16)

5 2016 Nomination for Driver Of the Month Driver Home Address Date of Birth Marital Status Number of Children License Number State Social Security # Employers Name Employer Address City State Zip Telephone Fax Years of Driving: Present Employer Previous Employer Mileage: Present Employer Previous Employer Equipment Operated: Straight Truck 3-Axle Semi 4-Axle Semi 5-Axle Truck Twin Trailer Type of Driving: Local Delivery Terminal to Terminal Long Haul Accident Record Number Chargeable Number Non-Chargeable Traffic Non-Traffic Traffic Non-Traffic Present Employer Previous Employer Date of Last Chargeable Accident Date of Last Non-Chargeable Accident Date of Last Traffic Violation or Citation Offense Has driver previously been a Driver of the Month? Yes No Year (Driver may be disqualified if information contained on this form is incorrect.) Name of person making nomination Title Phone Date of submission Return to: WVTA RETURN NO LATER THAN MAY 8, 2017

6 WV Fleet Safety Contest 2016 Annual Report Form Reporting requirements for the West Virginia Truck Fleet Safety Contest: 1. A separate form must be filed for each major division representing a type of service performed within the state. 2. Statistics and rates must be listed for West Virginia, no system wide operations. Frequency rates shall be expressed in terms of the number of accidents per one million miles as determined by the following formula: Frequency = Number of DOT Reportable Accidents x 1,000,000 Total Mileage Name of Contestant Address City State Zip Phone Fax Contest division - check one: General Commodities Heavy Haulers Tank Trucks Auto Transporters Household Goods Vehicle Trans. (Driveway) Private Carriers Miscellaneous (Specify) A separate report must be filed for each division entered. All divisions must have a minimum of five participants before the division will be judged in the contest. Contestants will be notified if their division has less than five entries. Total WV DOT Reportable Accidents Total WV Mileage Frequency Ratio Combined Intercity/ Interterminal Local Delivery I hereby certify that the information submitted above is correct to the best of my knowledge and belief. I agree that a check of the record may be made prior to the announcement of any award to this organization. Name Signature Title Phone Return to: WVTA RETURN NO LATER THAN MAY 8, 2017

7 2016 Nomination for Safety Professional of the Year Rules I. Purpose The individual nominated for the West Virginia Trucking Association s Safety Professional of the Year Award is a person responsible for supervising activities for a truck fleet. This person is of high moral character and has devoted his or her career to the field of highway and industrial safety. II. Eligibility for Nomination 1. The West Virginia Safety Professional of the Year Award will be presented under the rules established by the WVTA Safety Management Council. 2. Nominees for the Safety Professional of the Year Award must be persons employed full time by a member of the West Virginia Trucking Association performing activities in a truck fleet whose primary duties include loss prevention in highway and industrial safety. 3. Nominees should also be a member of the WVTA Safety Management Council for the last year with an active membership attendance. 4. Nominations may be made by any person. 5. As a condition of being nominated, the nominee and the fleet in which he is employed must grant the nominating committee complete and full authority and freedom to investigate his and its records and premises to determine for itself his qualifications, progress and success which made the nominee eligible to receive this award. In turn, the Nominating Committee guarantees to hold the results of such investigation confidential. 6. Unsuccessful nominations may be resubmitted the following year by completing the current year s application. 7. The Nominating Committee shall consist of three people: Previous year s winner, plus the present Chairman of the Safety Management Council, shall appoint additional representatives from the WV State Police, a member of the Safety Management Council, or other industry representative, such as an insurance executive, USDOT or WVSPC representative. 8. All nomination forms must be submitted to the WVTA Office no later than May 16, These applications will then be turned over to the Committee Chairman. III. The Award The winner will be presented the West Virginia Safety Professional of the Year plaque at the Annual Safety Awards Banquet.

8 2016 Nomination for Safety Professional of the Year Name of Nominee Title Company Address City State Zip Telephone Fax 1. Total number of miles operated in the entire fleet: Total number of accidents reportable to Department of Transportation (property damage of $4, or more, death or bodily injury) Number of accidents which were preventable Number of accidents which were non-preventable Accident frequency. Total reportable accidents times one million miles divided by total miles operated List any special safety accomplishments or activities. (Attach additional pages if necessary.) 7. I am a member of the WVTA Safety Management Council Yes No I certify that the above is true and correct. Nominee Signature Company Officer Signature Name of Company Officer Title Date Return to: WVTA RETURN NO LATER THAN MAY 8, 2017

9 2017 Truck Driving Championships Lunch Order Form (Includes hamburger, chips, drink) I wish to purchase $10.00 each Check enclosed Company Contact Address City State Zip Phone Fax Signature Return to: WV Trucking Association traci@omegawv.com

10 2017 Awards Dinner (Includes steak, potato salad, baked beans, rolls and drink) Ticket Request Form I wish to purchase $40.00 each Check enclosed Company Contact Address City State Zip Phone Fax Signature Return to: WV Trucking Association traci@omegawv.com