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TRUCRUS-01 _ COF F
<br />AORO DATE (MMIDD/YYYY)
<br />lv� INSURANCE z/zoizozo
<br />... ......... _._________.______.CERTIFICATE ..
<br />OF LIABILITY ...... _ .......... ..............
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />r
<br />IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer ri hts to the certificate holder in lieu of such alTdorselTTBlTts).
<br />---------- — — -- - ........ ern .- --
<br />PRODUCER CONTACT -..... -..------ ,...,...,
<br />NAME:
<br />Miller Insurance Group
<br />eZe' �446 3341
<br />AC "N"o
<br />i J 4 546-2687BrremnIN 46506 E-MAILE-y o ullq rinsuranccrp.com
<br />INSURED
<br />Trucks R Us, Inc.
<br />Lake Effect Snow Excavating
<br />23300 State Road 23
<br />South Bend, IN 46619
<br />RERA:Ohio Security InSuran
<br />C:
<br />/ERAGE NAIC #
<br />�O �24082
<br />nce .. � 'I a350
<br />, COVERAGES CERT,IFICATE NUMBER:
<br />-... A#ON hlBER:
<br />-THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY I'EiRl01�
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 1'0 WIIICII TI IIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI_I_ THE I FIRMS
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS„
<br />TYPE OF 11MMI'ooryyy" INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br />LT X COMMERCIALOGENERR..., ..L O y!!y�%T.......... ,............ '), ,IIVIOMIQI,6myiXY�,,, ]�. .. ..... ......
<br />INSURANCE POLICY NUMBER
<br />AL LIABILITY 1,000,000
<br />.., CLAIMS -MADE X OCCUR PREMISES TO PE N F0
<br />BKS56685229 7/5/2019 7/5/2020�
<br />Faces Oc,,,
<br />�_� f PEN urr 300,000
<br />(Fa otci.rmrerrcoY �
<br />15,000
<br />EXP /A.ny orre,persnnj.... ,....
<br />1,000,000
<br />PER C1NAt F AOV IWURY
<br />....
<br />RAJWLAlGR GA"]F LIMIT API APPLIES PER:
<br />GENERALAGGREr..,.
<br />ATE
<br />2,000,000
<br />POLICY � X] E I I C7C,
<br />...._ .. ....
<br />'....
<br />. ,.... ,
<br />2,000,000
<br />..... 1LQ,T
<br />PROD CT COMP/OP AGQ
<br />$
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<br />AUTOMOBILE LIABILITY
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<br />�"tTMull11MJ'�t�P�� rINGLELIMIT
<br />1,000,000
<br />X ANY AUTO
<br />A040137
<br />7/5/2019
<br />7/5/2020
<br />ILY Per rr9on
<br />OWNED SCHEDULED
<br />...
<br />AUTOS ONLY AUTOS
<br />_ .JURY (PPr acrsr{enl
<br />�
<br />HIRED NON -OWNED'
<br />PR�IIURY
<br />Y DAMAGE
<br />�t
<br />_....
<br />''. AUTOS ONLY . AUTOS ONLY
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<br />(Per'
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<br />UMBRELLA LIAB OCCUR
<br />G 0 C'
<br />,., CURRFNC'E
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<br />_
<br />EXCESS LIAB CLAIMS MADE
<br />AGGREGATE
<br />ATE
<br />-
<br />.. ......
<br />DED O...RETENTION ...._
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<br />KERSEMPL COMPENSATION
<br />N D EMPLOYERS'
<br />.....� ..
<br />_
<br />�,.7/5/2020
<br />L r(-
<br />�.�,,..,
<br />LIABILITY
<br />Y fI N
<br />AND PROPS EBER
<br />A040149�......
<br />7/5/2019�
<br />.XI STAT�f FS�.
<br />s00,.
<br />Y EARTNERtEXECUTIVE
<br />I
<br />st,,9 FICs[RtMEMBER EXCLUDED?
<br />in NH .....
<br />N I A
<br />EACH ACCI�ENT�
<br />_. ._ ._ ..,... ,.,, .m
<br />.. , ®,
<br />500,00(1
<br />0
<br />q anrlator
<br />L D{SFASF F,A FMPI OYE;.F,
<br />A
<br />If yes describe under
<br />DLSC,RIPTION OF 7P,FRATIQNS,kietow_...
<br />,,,E
<br />FC(SFASF -PG I,CY,l IMIT
<br />500,000
<br />B
<br />Motor Truck Cargo
<br />--—.__.
<br />A040137
<br />_._
<br />7/5/2019
<br />7/5/2020
<br />Cargo
<br />—..
<br />100,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />CERTIFICATE
<br />City of South Bend I St Joseph County
<br />Board of Public Works 125 S. Lafayette Bid, #100
<br />South Bend, IN 46601
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATI
<br />ON. All rights reserved,
<br />The ACORD name and logo are registered marks of ACORD
<br />
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