acorq- certificate of liability insurance
Transcription
acorq- certificate of liability insurance
Fronr: FA)ftnaker T o : (-5 5 9 ) 441-1512 P a g e :1 i2 01 AlvI 10.0-5 Date:11/112010 DATE (MM,/DDA/YYY) ACORQ- CERTIFICATEOF LIABILITYINSURANCE T S S U E DA S A M A T T E Ro F I N F O R M A T I o N ffi ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H O L D E R . T H I S C E R T I F I C A T ED O E S N O T A M E N D , E X T E N D O R A L T E R T H E C O V E R A G EA F F O R D E DB Y T H E P O L I C I E SB E L O W ' PRoDUCER (510\ 452-4600 FAII: (510\ 452-4603 T.INKS INSURANCE SERVTCES , rNC. 1155 THIRD ST # 220 CA oAIG,AI{D 94607 INSURED TRIUS TRUCI{ING, P. O. BOX 2700 NAIC# I N S U R E R SA F F O R D I N G C O V E R A G E & GEN ri\rsrRERe NEW YORK b4ARINE ir\si,REFie IJEXINGTON INC . LL/ L/ zALa INS . 16608 L9437 INS CO. ] N S L ] R E RC NISt]RER D CA FRESNO 937 45-2700 l N 5 r - r FE F E D I N D I C A T E DN O T W I T H S T A N D I NAGN Y O F A N Y C O N T R A C TO R O T H E R D O C U M E N TW I T H R E S P E C TT O W H I C HT H I S C E R T I F I C A I EM A Y B E I S 5 U E DO R M A Y P E R T A I N ' R E O U I R E M E N TT, E R I \ ,O] R C O N O I T I O N OF SUCH POLICIES' T H E I N S U R A N C EA F F O R D E DB Y T H E P O L I C I E SD E S C R I B E DH E R E I N I S S U B J E C TT O A L L T H E T E R M S , E X C L U S I O N SA N D C O N D I T I O N S NWN MA\/ I.]A\,IFRFFN RFn| I{:FD BY PAID CLAIMS potrcv exetnnrtorul P O L I C YE F F E C T I VIE T -Nr PS R I A D D L I LIMITS DATE (MMiOD/YY)I DATE(MM/DDI/Y)I P O L I C YN U M B E R T Y P EO F I N S U R A N C E I | ltr\teanl F l l. o * * r ^ c r A L G E N E R A LL rABrLrrY -Tcr100912 c LA r M S r oIoxul o rrc .rR --r-- A ACH OCCTIRRENCE s D A M A G ET O R E N T E D $ PRFN/ISFS 0 7/ 2 0 / 2 O L 0 7 / 2 0 / 2 0 L L (F:] OI:{,I]TTt s s s s 5,000 1 , 0 0 0, 0 0 0 2,000,000 1,000,000 C O r \ 4 B l NE D S l N l ( 3 L EL i f v l l T (Ea accrd{tnl) ,$ 1,000,000 B C ) D I L Yl N . r r - l F r Y (Per lersnn) $ Y BOt)ILY INJ{_IR (Per aijo(lent) $ PROPERTY C)AI,4AGE (Per at'ctdent) I A L J T OO N L Y . E A A C C I D E N T $ MED EXF lArtv one oersc,rr) F , F R S O N A L 8 ,A D V I 5 1 , . j L I P ' _-1 G E N E R A LA G G R E ( : A T E ---J t r R C ] T JJIC . T : - ' O [ , 1 P I O F N . G G G E N ' L A G G R E G A T E L I M I T U t ' p ' t 1 9 1 :F ' E F l 1 , 0 0 0, 0 0 0 xl on,,.',l--l ?FPrl-_l ,..r.., -1"ffi::r'AB'L'rY A I A L LO W N E DA L I T O S El cr100912 o 7/ 2 0 / z O L o 7 / 2 0 / 2 O L L = , , n . o , , L E DA i - r r o : i x I *,o.o Al,rros El n,on, .*NEDAlrro:; _l -l --l o* o.,to FACH E X C E S S r u M B R E L LLAI A B I L I T Y _l o...,* ,\'J U $ $ O(^.Cl IRRFI\lCF $ AGGREGATE q -l --l o.o,,,.r,r,-, -,-.,-^^", $ $ WC STATU- T-PV WORKERS COMPENSATION AND EMPLOYERS'LIABILITY I IN/IT'] oTt-itrp E,L.EACH ACCIDENT A N Y P R O P R I E T O R i P A R T N E R / E ) ( E C JI T I V F OFFI CERiN4EMBER EXCLLJDED? E . L D I S E A S E . P O L I C YT I M I T orHER CARGO CO\ZERAGE $ E . L D I S E A S E - E A E I . / F ' L O Y E E$ lf ves. descflbeunder SPECIAL PROVISIONS below B EA ACC OTHER THANI AI-]TO ONLY. 0]-2-944 - 65 8- 0 1 tL/04/2oLO LL/ 4/2OL1 $ c A R 6 oL r r . r r r s R E E F E RB R E A K D o wDNE D cotllsroll DEDUCTIBLE $1oo'ooo $2,500 $1 . q! I PROVISIONS D E S C R T P T I O N O F O P E R A T I O N S I L O C A T I O N S A / E H I C L E S / E X C L U S I O N SA D D E D B Y E N D O R S E M E N T X S P E C I A L COMPANY INSURANCE WITH ON FILE LISTED VEHICLES CANCELLATION HOLDER CERTIFICATE FOR FOR INSURED INSURED THE S H O U L D A N Y O F T H E A B O V E D E S C R I B E DP O L I C I E SB E C A N C E L L E DB E F O R E PURPOSES PURPOSES ExPIMT|oNDATETHEREoF.THEISSulNG|NSURERWLLENDEAVoRTOMA|L E O L D E RN A M E DT O T H E L E F T ' B U T T O T H E C E R T I F I C A TH L0 D A y S \ / R | T T E NN O T T C E O F A N Y K I N DU P O N T H E LIABILITY O R O B L I G A T I O N N O I M P O S E F A I L U R ET O D O S O S H A L L ONIrY ONIrY INSURER,ITS AGENTSoR REqEESENf4TIVES' AUTHORIZEDREPRESENTATIVE I. A C O R D2 5 ( 2 0 0 1 / 0 8 ) l N S 0 2 5 ( { rt r l r -ci )t a RANDTAWA c , A C O R DC O R P O R A T I O1N9 8 B Pl,te com visit:http://rnnnrur'gfi Thisfax was sent with GFI FAXmakerfax server.For moreInformation, I ';t :
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