Georgia Truck COI

                                                                                                                                                                  DATE (MM/DD/YYYY)
                                                CERTIFICATE OF LIABILITY INSURANCE                                                                                   
  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                                                                                    CONTACT
                                                                                            NAME:
0DUVK 0F/HQQDQ $JHQF\ //&                                                                   PHONE                                                   FAX
 &RUSRUDWH 3DUN 'ULYH                                                                   (A/C, No, Ext):                             (A/C, No):
                                                                                            E-MAIL
2SHOLND $/                                                                             ADDRESS:
                                                                                                               INSURER(S) AFFORDING COVERAGE                                   NAIC #

                                                                                            INSURER A : +RPH2ZQHUV ,QVXUDQFH &RPSDQ\                                          
INSURED                                                                     *(25*758&.
                                                                                            INSURER B : $XWR2ZQHUV ,QVXUDQFH                                                  
*HRUJLD 7UXFN 7UDLOHU //&
                                                                                            INSURER C : 2ZQHUV ,QVXUDQFH &RPSDQ\                                               
32 %R[ 
&RQOH\ *$                                                                              INSURER D :

                                                                                            INSURER E :

                                                                                            INSURER F :
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.
INSR                                               ADDL SUBR                                         POLICY EFF   POLICY EXP
 LTR               TYPE OF INSURANCE               INSD WVD             POLICY NUMBER               (MM/DD/YYYY) (MM/DD/YYYY)                            LIMITS
 %         COMMERCIAL GENERAL LIABILITY                                                             EACH OCCURRENCE                $ 
                                                                                                                                  DAMAGE TO RENTED
                 CLAIMS-MADE         OCCUR                                                                                        PREMISES (Ea occurrence)       $ 
       ;    *DUDJH /LDELOLW\                                                                                                      MED EXP (Any one person)       $ 

                                                                                                                                  PERSONAL & ADV INJURY          $ 
       GEN'L AGGREGATE LIMIT APPLIES PER:                                                                                         GENERAL AGGREGATE              $ 
                      PRO-
           POLICY     JECT          LOC                                                                                           PRODUCTS - COMP/OP AGG         $ 

           OTHER:                                                                                                                                                $
                                                                                                                                  COMBINED SINGLE LIMIT          $ 
 $     AUTOMOBILE LIABILITY                                                                         (Ea accident)
       ;   ANY AUTO                                                                                                               BODILY INJURY (Per person)     $
           OWNED                   SCHEDULED                                                                                      BODILY INJURY (Per accident) $
           AUTOS ONLY              AUTOS
           HIRED                   NON-OWNED                                                                                      PROPERTY DAMAGE
       ;   AUTOS ONLY
                               ;   AUTOS ONLY                                                                                     (Per accident)                 $

                                                                                                                                                                 $
 &     ;   UMBRELLA LIAB             OCCUR                                                          EACH OCCURRENCE                $ 
           EXCESS LIAB               CLAIMS-MADE                                                                                  AGGREGATE                      $ 

              DED     ; RETENTION $                                                                                                                              $
                                    
                                                                                                                                       PER             OTH-
 %     WORKERS COMPENSATION                                    $                                    ;     STATUTE         ER
       AND EMPLOYERS' LIABILITY              Y/N
       ANYPROPRIETOR/PARTNER/EXECUTIVE                                                                                            E.L. EACH ACCIDENT             $ 
       OFFICER/MEMBER EXCLUDED?                    N/A
       (Mandatory in NH)                                                                                                          E.L. DISEASE - EA EMPLOYEE $ 
       If yes, describe under
       DESCRIPTION OF OPERATIONS below                                                                                            E.L. DISEASE - POLICY LIMIT    $ 




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.
                 'HNDOE &RXQW\ 6FKRRO 'LVWULFW
                  0RXQWLDQ ,QGXVWULDO %OYG                                              AUTHORIZED REPRESENTATIVE
                 6WRQH 0RXQWDLQ *$ 


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ACORD 25 (2016/03)                                   The ACORD name and logo are registered marks of ACORD