certificate of liability insurance

DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 1/31/2015
3/18/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
INSURED
CONTACT
NAME:
PHONE
(A/C, No, Ext):
E-MAIL
ADDRESS:
A-Lockton Companies, LLC
3280 Peachtree Rd NE, Suite #250,
Atlanta, GA 30305
B-AON Risk Services West Inc.
199 Fremont St, Ste 1500
San Francisco CA 94105
FAX
(A/C, No):
INSURER(S) AFFORDING COVERAGE
Crane Cartage, LLC
1376331 dba: Crane Cartage Freight Services
1500 Rankin Road
Suite 400
Houston TX 77073
INSURER A :
Liberty Mutual Fire Insurance Company
INSURER B :
INSURER C :
Farmington Casualty Company
Lexington Insurance Company
INSURER D :
Starr Indemnity & Liability Company
NAIC #
23035
41483
19437
38318
INSURER E :
INSURER F :
COVERAGES
A
CERTIFICATE NUMBER:
12112551
REVISION NUMBER:
XXXXXXX
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
A
ADDL SUBR
INSR WVD
TYPE OF INSURANCE
GENERAL LIABILITY
X
N
N
POLICY NUMBER
TB2-651-291017-034
POLICY EFF
POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
1/31/2014
1/31/2015
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE X OCCUR
X Annual Agg Cap $10M
GEN'L AGGREGATE LIMIT APPLIES PER:
PROPOLICY
JECT
LOC
AUTOMOBILE LIABILITY
X
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
C
X
UMBRELLA LIAB
EXCESS LIAB
N
N AI2-655-291017-014
1/31/2014
1/31/2015
SCHEDULED
AUTOS
NON-OWNED
AUTOS
X
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
$
COMBINED SINGLE LIMIT
$
(Ea accident)
BODILY INJURY (Per person) $
N 048883267
1/31/2014
1/31/2015
CLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
X
B
DED
RETENTION $ 10,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
D
Y
Motor Truck Cargo
$
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
$
(Per accident)
$
N
OCCUR
$
PRODUCTS - COMP/OP AGG $
X
A
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
N PF-UB-0D635362-14
3/31/2014
1/31/2015
N/A
N
N MASICSF0088US14
1/31/2014
1/31/2015
X
WC STATUTORY LIMITS
1,000,000
1,000,000
10,000
1,000,000
2,000,000
1,000,000
1,000,000
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
3,000,000
3,000,000
XXXXXXX
OTHER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
1,000,000
1,000,000
1,000,000
Any One Vehicle - $250,000
Deductible - $10,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Broker A listed above represents broker for General Liability, Auto, Umbrella and Workers Compensation coverages. Broker B listed above represents broker
for Motor Truck Cargo coverage.
If Applicable: Trailer Interchange Coverage $50,000 Limit Per Trailer - Liberty Mutual Fire Ins. Co. Policy
#AI2-655-291017-014; Effective: 1/31/2014 to 1/31/2015. Jose Sanchez/Jose A Sanchez Trucking LLC, ELP351866, 2005 International 9400 Eagle,
vin#3HSCNAPR45N051866
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
12112551
AUTHORIZED REPRESENTATIVE
EVIDENCE OF INSURANCE
1500 RANKLIN ROAD, SUITE #400
HOUSTON TX 77073
ACORD 25 (2010/05)
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