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CROSAMB-01 VSULLIVAN
<br />ACORO CERTIFICATE OF LIABILITY INSURANCE D12/23/MY015
<br />2/235
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FIQLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />—SLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />'IPRODUCER
<br />IT. Charles Wilson Insurance Service
<br />384 Inverness Parkway Suite 170
<br />Englewood, CO 80112
<br />INSURED
<br />Crossroads Ambulance Sales & Service, LLC
<br />21912 Protecta Drive
<br />Elkhart, IN 46516
<br />is°NN W-0303) 368-5757 (aC, NI: (303) 368-5863
<br />E-MAIL
<br />ADDRESS: info@wilsonins.com
<br />INSURER(S) AFFORDING COVERAGE NAIC_k__
<br />INSURER A:ArchInsurance Company 11150
<br />INSURER B:TravelersInsurance Company 38130
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF
<br />ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
<br />THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
<br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILDL SUER' - - -
<br />TR, TYPE OF INSURANCE NI We POLICY NUMBER
<br />INSp
<br />-
<br />POLILYEFF POLICY EXP
<br />MM/DD/YYYIr I MM/DD/YYYV UNITS
<br />- -
<br />-A X: COMMERCIAL GENERAL LIABILITY
<br />EACHOCCURRENCE $
<br />1,000,00
<br />CLAIMS -MADE X MFPK07331303
<br />OCCUR
<br />DAMAGETOIIERTEu-"—___.—
<br />12/01/2015 12/01/2016 PREMISES(Eaocorrence)_ i$
<br />Solo_
<br />X Additional Insured___
<br />MED I(Any one person) 1$
<br />5,00
<br />X Requied by contract
<br />PERSONAL &AOV INJURY I $
<br />1,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />GENERAL AGGREGATE $
<br />2,000,00
<br />X POLICY PRO-
<br />JECT -_ _� LOG
<br />PRODUCTS - COMPIOP AGG $
<br />2,000,00
<br />_ OTHER'.
<br />'Garage Liabilit $
<br />Included
<br />AUTOMOBILE LIABILITY
<br />_ _
<br />COMBINED SINGLE LIMIT $
<br />CO BINEDU
<br />1,000,00
<br />A ANYAUTO MFCA06034603
<br />12/01/2015 12/01/2016 BODILY INJURY (Per person) $ -
<br />__
<br />_
<br />ALL OWNED SCHEDULED
<br />'AUTOS ,AUTOS
<br />BODILY INJURY (Per accident) $
<br />X X NON -OWNED
<br />: HIRED AUTOS AUTOS I
<br />PROPERTY DAMAGE
<br />(Per acodeMZ $
<br />_
<br />UMBRELLA LIAR ,X OCCUR
<br />EACH OCCURRENCE $
<br />1,000,000
<br />A X : EXCESS LIAR _ CLAIMS -MADE MFUM07982803
<br />12/01/2015 12/01/2016 AGGREGATE : $
<br />1,000,00
<br />DED � X i RETENTION' 0,
<br />$
<br />WORKERS COMPENSATION
<br />- PER WIN -
<br />X STATUTE 1
<br />AND EMPLOYERS' LIABILITY
<br />Yj-��N/A
<br />DER
<br />B 'M ANY PROPRIETORIPARTNER/EXECUTIVE IJUB2609P63216
<br />0111812016, 01/1812017 EL EACH ACCIDENT $
<br />1o0,00
<br />OFFICERIMEMBER EXCLUDED9 u
<br />- - - —
<br />(MandatoryinNH)
<br />E. L. DISEASE - Ea EMPLOYEE IS
<br />100,00
<br />,r •_� des„rbaunder
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE -POLICY LIMIT $
<br />500,0o
<br />A Stock Autos �MFPK07331303
<br />12/01/2015 12/0112016
<br />1,600,00
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may
<br />Ile attached N more space is required)
<br />PROPERTY provided on a Replacement Cost basis, except Actual Cash Value on Stock Autos (Including Customer Autos); 80 % Coinsurance, $1,000
<br />Deductible per Occurrence; Special form Causes of Loss Intl Theft
<br />Crossroads Ambulance Sales & Service, LLC
<br />21912 Protects Drive
<br />Elkhart, IN 46516
<br />ACORD 25 (2014/01)
<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 />VM& ��-
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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