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    InsuranceCertificateAcordformatSample 230513 185325

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    Ismacum Ahm

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    InsuranceCertificateAcordformatSample 230513 185325

    Uploaded by

    Ismacum Ahm
    2 views1 page

    Original Title

    InsuranceCertificateAcordformatSample-230513-185325

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    2 views1 page

    InsuranceCertificateAcordformatSample 230513 185325

    Uploaded by

    Ismacum Ahm

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    DATE (MM/DD/YYYY)

    ACORD CERTIFICATE OF LIABILITY INSURANCE


    TM 07/12/2012
    PRODUCER765.463.1878 FAX 765.463.1313 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
    Truck Insure, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
    HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
    2540 Kent Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
    West Lafayette, IN 47906
    INSURERS AFFORDING COVERAGE NAIC #
    INSURED Alfa X Logistics LLC INSURER A: Plaza Insurance Company
    695 Plyant Street INSURER B: One Beacon Insurance Company
    Atlanta, GA 30306 INSURER C:

    INSURER D:
    INSURER E:

    COVERAGES
    THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
    ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
    MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
    POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
    INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
    LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS
    GENERAL LIABILITY EACH OCCURRENCE $
    COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $
    PREMISES (Ea occurence)
    CLAIMS MADE OCCUR MED EXP (Any one person) $
    PERSONAL & ADV INJURY $
    GENERAL AGGREGATE $

    GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $


    PRO-
    POLICY JECT LOC

    AUTOMOBILE LIABILITY BAP1502711-00 07/20/2012 07/20/2013 COMBINED SINGLE LIMIT


    (Ea accident) $
    ANY AUTO 1,000,000
    ALL OWNED AUTOS
    BODILY INJURY
    $
    (Per person)
    X SCHEDULED AUTOS
    A
    HIRED AUTOS
    BODILY INJURY
    $
    (Per accident)
    NON-OWNED AUTOS

    PROPERTY DAMAGE
    $
    (Per accident)

    GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $


    ANY AUTO EA ACC $
    OTHER THAN
    AUTO ONLY:
    AGG $

    EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $

    OCCUR CLAIMS MADE AGGREGATE $


    $

    DEDUCTIBLE $

    RETENTION $ $
    WC STATU- OTH-
    WORKERS COMPENSATION AND TORY LIMITS ER
    EMPLOYERS' LIABILITY
    E.L. EACH ACCIDENT $
    ANY PROPRIETOR/PARTNER/EXECUTIVE
    OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
    If yes, describe under
    SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
    OTHER BAP1502711-00 07/20/2012 07/20/2013 $1,000 DEDUCTIBLE
    PHYSICAL DAMAGE (A)
    A MOTOR TRUCK CARGO (B) 790011481-0000 07/20/2012 07/20/2013 $100,000 LIMIT
    $1,000 DEDUCTIBLE
    DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
    ALL UNITS ON FILE WITH INSURANCE COMPANY.

    CERTIFICATE HOLDER CANCELLATION


    SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
    EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL

    _______ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
    BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
    OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
    AUTHORIZED REPRESENTATIVE

    Torrin Bottrell/VICKY
    ACORD 25 (2001/08) ©ACORD CORPORATION 1988

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