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HomeMy WebLinkAboutCOI - ATI Trucking, LLC - Expires 2024-08-01CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 DATE (MM/DD/YYYY) 03/21/2023 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). PRODUCER Willis Towers Watson Midwest, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA INSURED American Transport, Inc.; ATI Trucking, LLC; American Wind Transport Group, LLC 200 Airaide Drive, Suite 260 Moon Township, PA 15108 CONTACT Willis Towers Watson Certificate Center NAME: PHONEfra- 1-877-945-7378 1-888-467-2378 LAIC. No. EMI:(AtC, N4): E-MAILSS: certificates@willis.com INSURERS) AFFORDING COVERAGE NAIC 4 INSURER A : RLI Insurance Company 13056 INSURER B • Lexington Insurance Company 19437 INSURER C: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W28389859 REVISION NUMBER: THIS IS TO CERTIFY INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE EXCLUSIONS AND CONDITIONS THAT THE POLICIES ANY REQUIREMENT, ISSUED OR MAY OF SUCH IADDL'SUBR OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY PERIOD TO WHICH THIS ALL THE TERMS. ILT R LTR OF IGENERALURA -- — POLICY NUMBER POLICY EFF INSD WVD � {MM/DO/YYYY) _ _ POLICY EXP {MM/AD/YYYY) , UtiQ7S A COMMERCIALTYPE X LIABILITY LGL0012094 04/01/2023 08/01/2024 , EACH OCCURRENCE $ 1,000, 000 I i CLAIMS -MADE ,-X N OCCUR DAMAGETO RENTED PREMISES (Ea accurrenceL $ $ 5, 000 MED EXP (Any one person) PERSONAL 8 ADV INJURY $ 1,000, 000 GENII AGGREGATE LIMIT APPLIES PER: -CT t LOC GENERAL AGGREGATE $ 1, 000, 000 $ 1 , X POLICY PRO JE000,000 i PRODUCTS - COMP/OP AGG y OTHER: $ A AUTOMOBILE UABIUTY X ! ANY AUTO i SCHEDULED AUTOS Y LFT0013314 04/01/2023 08/01/2024 COMBINED SINGLE LIMIT $ 1, 000, 000 Aga accident) • BODILY INJURY (Per person) $ X', OWNED AUTOS ONLY BODILY INJURY (Per accident) $ XHIRED AUTOS ONLY NON -OWNED AUTOS ONLY i PROPERTY DAMAGE $ (Peraccident)_ _ $ UMBRELLA LIAB s OCCUR EACH OCCURRENCE $ EXCESS UAB : CLAIMS -MADE AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORtPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) II yes, describe under DESCRIPTION OF OPERATIONS Y / N N t A PER • OTH- �� STATUTE i I ER E.L. EACH ACCIDENT E.L. DISEASE • EA EMPLOYEE , $ $ below - - E.L. DISEASE • POLICY LIMIT L $ B Motor Truck Cargo 51567017 08/01/2022 Other deductibles may apply as per policy terms and conditions 08/01/2023 Limit: Deductible: $100,000 I$5,000 DESCRIPTION OF OPERATIONS t LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Tariff rules and regulations limit carrier's liability to a max of $1.50/lb for each article transported, or $0.10/lb for shipments of used or reconditioned goods. If value in excess of these limits is declared, see tariff rules and regulations for complete procedures to which shipper is subject. It is agreed that the carrier's liability on any shipments tendered by a certificate holder is limited to an amount not to exceed the limit listed above. Higher limits are available upon request and are effective upon confirmation in writing from the corporate headquarters of the motor carrier. Drivers or agents have no authority to amend wording or limits. CERTIFICATE HOLDER CANCELLATION CITY OF GILROY ATTN: PUBLIC WORKS DEPT ROSANNA ST GILROY, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ernpul, ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR IS: 23861171 BATCH: 2900904 4 of 5 11031 AGENCY CUSTOMER ID: LOC #: .CORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Willis Towers Watson Midwest, Inc. POLICY NUMBER See Page 1 CARRIER See Page 1 NAIC CODE See Page 1 NAMED INSURED American Transport, Inc.; ATI Trucking, LLC; American Wind Transport Group, LLC 200 Aireidn Drive, Suite 260 Moon Township, PA 15108 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance CITY OF GILROY IS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY AND AUTO LIABILITY AS REQUIRED BY WRITTEN CONTRACT. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 23861171 BATCH: 2900904 CERT: W28389859 Policy Number: LFT0013314 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: TRUCKERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM GENERAL LIABILITY COVERAGE FORM EXCESS INDEMNITY COVERAGE FORM MOTOR TRUCK CARGO COVERAGE FORM COMMERCIAL EXCESS LIABILITY POLICY MOTOR CARRIER COVERAGE FORM The provisions of the Coverage Form apply unless modified by this endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 04/01/2023 Named Insured: American Transport, Inc.; ATI Trucking, LLC; American Wind Transport Group, LLC Additional Insured shall include any organization where shown on a Certificate of Insurance or to whom the Named Insured is obligated by virtue of a written contract or agreement to provide insurance but only as respects the operations of the Named Insured. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. TRS 601 (11/06) Page 1 of 1 5 of 5 11031 Policy Number: LGL0012094 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: TRUCKERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM GENERAL LIABILITY COVERAGE FORM EXCESS INDEMNITY COVERAGE FORM MOTOR TRUCK CARGO COVERAGE FORM COMMERCIAL EXCESS LIABILITY POLICY MOTOR CARRIER COVERAGE FORM The provisions of the Coverage Form apply unless modified by this endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 04/01/2023 Named Insured: American Transport, Inc.; ATI Trucking, LLC; American Wind Transport Group, LLC Additional Insured shall include any organization where shown on a Certificate of Insurance or to whom the Named Insured is obligated by virtue of a written contract or agreement to provide insurance but only as respects the operations of the Named Insured. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. TRS 601 (11/06) Page 1 of 1