DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 9/24/2020
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).
CONTACT
PRODUCER
NAME: Deb Gwyn
Szura Insurance Services PHONE FAX
109 E. Fourth St. (A/C, No, Ext): 248-651-4487 (A/C, No): 248-651-3751
E-MAIL
Rochester MI 48307-2021 ADDRESS:
[email protected] INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Acuity A Mutual Insurance Co 14184
EDXTR-1
INSURED INSURER B : Travelers Indemnity Co. 25682
EDX Transport LLC
5131 Middlesex Street INSURER C :
Dearborn MI 48126 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1490980898 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.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY ZA3805 6/7/2020 6/7/2021 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO-
POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
A COMBINED SINGLE LIMIT $ 1,000,000
AUTOMOBILE LIABILITY ZA3805 6/7/2020 6/7/2021 (Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED
AUTOS ONLY
X SCHEDULED
AUTOS
BODILY INJURY (Per accident) $
NON-OWNED
X HIRED
AUTOS ONLY
X AUTOS ONLY
PROPERTY DAMAGE
(Per accident) $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
PER OTH-
B WORKERS COMPENSATION 6KUB-4N92324-2-20 5/2/2020 5/2/2021 X STATUTE ER
AND EMPLOYERS' LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000
A Motor Truck Cargo ZA3805 6/7/2020 6/7/2021 Cargo Limit 100,000
Cargo Deductible 1,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
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.
AUTHORIZED REPRESENTATIVE
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