Commercial truck General Workers Compensation
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PRIMBOX-01 RALWADI
CERTIFICATE OF LIABILITY INSURANCE gd
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 have ADDITIONAL INSURED provisions or 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)..
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ACCORD
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PRODUCER SeuEAcT Ranim Alwadi
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Robertson Ryan * Missouri e850 Tie, exy: 800-***-**** TRE noy877-***-****
‘Milwaukee, WI53202 Sales. ad5p4r@r.postjobfree.com
INSURER(S) AFFORDING COVERAGE nace
insurer a: Artisan and Truckers Casualty 10194
INSURED Pay
Prime Box Transport LLC INsuRER C=
1408 Vegas Valley Dr apt 396 INSURER D.
Las Vegas, NV 89169
INSURER E
INSURER
COVERAGES. CERTIFICATE NUMBER: REVISION NUMBER:
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,
se TYPE OF INSURANCE Tapa ava] POLICY NUMBER aoe Tn pane tums
COMMERCIAL GENERAL LABILITY TACHOGUURRENGE
ctams-Mape _ ] OCCUR PREUIRES (es osaurenoe) S
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PERSONAL ADV INLRY
GEN AGGREGATE LIMIT APPLIES PER ceneraLaccnecare
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SORES SGLE THAT 7,000,000)
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ANY AUTO x [974******-**/11/2023 10/11/2024 BooiLy INJURY (Per person) _ $
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EXCESS LIAB ctams-waoe peas
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WORKERS COMPENSATION PER OTH
AND SHB SERS HABIT viN stanure _lee
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handatry oN) EL DISEASE - EA EMPLOYE
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BEEP TON Se Secs arons below ex pisease poucvumir s
‘A [Motor Truck Cargo x (974******-**/11/2023 10/11/2024 100,000 7,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be atached if more space is required)
\Vehicle VIN: 1FTBR3X81MKA49942
IDRIVER: George Bouyagian
\vehicle value :$40,000 deductible is $1000 comprehensive and $1000 collision
CERTIFICATE HOLDER CANCELLATION
Ally Bank ABA/Routing Number:124003116 ACCORDANCE WITH THE POLICY PROVISIONS.
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200 West Civic Center Drive
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ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
‘The ACORD name and logo are registered marks of ACORD
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