INTERMODAL INTERCHANGE CERTIFICATE OF INSURANCE
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1 INSR DDL LTR INSR CRGO INTERMODL INTERCHNGE CERTIFICTE OF INSURNCE TYPE OF INSURNCE GENERL LIBILITY COMMERCIL GENERL LIBILITY CLIMS-MDE PER VEHICLE DED GEN'L GGREGTE LIMIT PPLIES PER: POLICY UTOMOBILE LIBILITY NY UTO OWNED UTOS ONLY SCHEDULED UTOS HIRED UTOS NON-OWNED UTOS DEDUCTIBLE POLICY EFFECTIVE POLICY EXPIRTION LIMIT PER VEHICLE TRILER INTERCHNGE PHYSICL DMGE LIMIT PER TRILER PER TRILER DED LIMITS ECH RENCE DMGE TO RENTED PREMISES (Ea occurence) MED EXP (ny one person) PERSONL & DV INJURY GENERL GGREGTE PRODUCTS - COMP/OP GG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY PROPERTY DMGE THIS CERTIFICTE IS ISSUED S MTTER OF INFORMTION ONLY ND CONFERS NO RIGHTS UPON THE CERTIFICTE HOLDER. THIS CERTIFICTE DOES NOT FFIRMTIVELY OR NEGTIVELY MEND, EXTEND OR LTER THE COVERGE FFORDED BY THE POLICIES BELOW. THIS CERTIFICTE OF INSURNCE DOES NOT CONSTITUTE CONTRCT BETWEEN THE ISSUING INSURER(S), UTHORIZED REPRESENTTIVE OR, ND THE CERTIFICTE HOLDER. Cedar Rapids I (319) (319) INSURER(S) FFORDING COVERGE NIC # BEST RTING INSURED INSURER : Landmark merican Insurance Company /24 INSURER B : INSURER C : INSURER D : INSURER E : COVERGES THE POLICIES OF INSURNCE LISTED BELOW HVE BEEN ISSUED TO THE INSURED NMED BOVE FOR THE POLICY PERIOD INDICTED. NOTWITHSTNDING NY REQUIREMENT, TERM OR CONDITION OF NY CONTRCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICTE MY BE ISSUED OR MY PERTIN, THE INSURNCE FFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO LL THE TERMS, EXCLUSIONS ND CONDITIONS OF SUCH POLICIES. GGREGTE LIMITS SHOWN MY HVE BEEN REDUCED BY PID CLIMS. Truenorth Companies 500 1st St Se DEDUCTIBLE 5,000 UMBRELL LIB EXCESS LIB DEDUCTIBLE CLIMS- MDE RETENTION WORKERS COMPENSTION ND EMPLOYERS' LIBILITY Y / N NY PROPRIETOR/PRTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIL PROVISIONS below LH CONTCT NME: Jason Duane Smith PHONE (319) (/C, No, Ext): E-MIL DDRESS: licensing@truenorthcompanies.com CUSTOMER ID #: 02/19/ /19/2019 ECH RENCE GGREGTE WC STTU- TORY LIMITS E.L. ECH CCIDENT FX (/C, No): (319) DESCRIPTION OF OPERTIONS / VEHICLES / EXCLUSIONS DDED BY ENDORSEMENT / SPECIL PROVISIONS (ttach CORD 101, dditional Remarks Schedule, if more space is required) The Truckers Uniform Intermodal Interchange Endorsement (Form UIIE-1 or C equivalent) is part of the auto policy(ies). The attached list of providers are additional insureds in regards to the auto liability. Those providers with (*) are additional insureds on the general liability and those with (**) are additional insureds on trailer interchange coverage. OTH- ER E.L. DISESE - E EMPLOYEE E.L. DISESE - POLICY LIMIT DED/LIMIT DED/LIMIT 02/15/ ,000 5,000 2,000,000 2,000,000 CERTIFICTE HOLDER President The Intermodal ssociation of North merica Beltsville Drive Suite 1100 Calverton, MD CNCELLTION SHOULD NY OF THE BOVE DESCRIBED POLICIES BE CNCELLED BEFORE THE EXPIRTION DTE THEREOF, NOTICE WILL BE DELIVERED IN CCORDNCE WITH THE POLICY PROVISIONS. UTHORIZED REPRESENTTIVE Truenorth Companies - I CORD 22 (2016/03) CORD CORPORTION. ll rights reserved.
2 Page 2 of 2 Truenorth Companies THIS FORM IS SCHEDULE TO CORD FORM, CORD CERTIFICTE OF INSURNCE To follow are additional insurance policies for the insured shown on the accord certificate: No other additional policies! ny person or organization that the insured is under a signed contract with, are named additional insured in regards to : General Liability Note: In addition to naming the companies indicated below additional insured on uto Liability (if applicable): (*) The companies below indicated with a single asterisk are additional insured on General Liability Policy. (**) The companies below indicated with a double asterisk are additional insured on Cargo and/or Trailer Interchange. Equipment Provider s List No separate named additional insureds have been provided for insured's policies. MOTOR COMPNY NME: DDRESS:, US PHONE: FX:
3 INSR DDL LTR INSR CRGO INTERMODL INTERCHNGE CERTIFICTE OF INSURNCE TYPE OF INSURNCE GENERL LIBILITY COMMERCIL GENERL LIBILITY CLIMS-MDE PER VEHICLE DED GEN'L GGREGTE LIMIT PPLIES PER: POLICY UTOMOBILE LIBILITY NY UTO OWNED UTOS ONLY SCHEDULED UTOS HIRED UTOS NON-OWNED UTOS DEDUCTIBLE POLICY EFFECTIVE POLICY EXPIRTION LIMIT PER VEHICLE LIMITS ECH RENCE DMGE TO RENTED PREMISES (Ea occurence) MED EXP (ny one person) PERSONL & DV INJURY GENERL GGREGTE PRODUCTS - COMP/OP GG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY PROPERTY DMGE 02/21/2018 THIS CERTIFICTE IS ISSUED S MTTER OF INFORMTION ONLY ND CONFERS NO RIGHTS UPON THE CERTIFICTE HOLDER. THIS CERTIFICTE DOES NOT FFIRMTIVELY OR NEGTIVELY MEND, EXTEND OR LTER THE COVERGE FFORDED BY THE POLICIES BELOW. THIS CERTIFICTE OF INSURNCE DOES NOT CONSTITUTE CONTRCT BETWEEN THE ISSUING INSURER(S), UTHORIZED REPRESENTTIVE OR, ND THE CERTIFICTE HOLDER. CONTCT NME: R. Dennis Schwartz 3912 Sunforest Court PHONE (419) FX (/C, No, Ext): (/C, No): (419) P.O. Box 8730 E-MIL DDRESS: glickl@roemer-insurance.com Toledo OH CUSTOMER ID #: (419) (419) INSURER(S) FFORDING COVERGE NIC # BEST RTING INSURED INSURER : merican Hallmark Insurance Co of TX /18/ INSURER B : XL Specialty Insurance Company /01/2 INSURER C : INSURER D : INSURER E : COVERGES THE POLICIES OF INSURNCE LISTED BELOW HVE BEEN ISSUED TO THE INSURED NMED BOVE FOR THE POLICY PERIOD INDICTED. NOTWITHSTNDING NY REQUIREMENT, TERM OR CONDITION OF NY CONTRCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICTE MY BE ISSUED OR MY PERTIN, THE INSURNCE FFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO LL THE TERMS, EXCLUSIONS ND CONDITIONS OF SUCH POLICIES. GGREGTE LIMITS SHOWN MY HVE BEEN REDUCED BY PID CLIMS. B DEDUCTIBLE UMBRELL LIB EXCESS LIB DEDUCTIBLE 5,000 CLIMS- MDE RETENTION WORKERS COMPENSTION ND EMPLOYERS' LIBILITY Y / N NY PROPRIETOR/PRTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIL PROVISIONS below HI-E UM M17 11/01/ /01/ /01/ /01/2018 ECH RENCE GGREGTE WC STTU- TORY LIMITS E.L. ECH CCIDENT DESCRIPTION OF OPERTIONS / VEHICLES / EXCLUSIONS DDED BY ENDORSEMENT / SPECIL PROVISIONS (ttach CORD 101, dditional Remarks Schedule, if more space is required) The Truckers Uniform Intermodal Interchange Endorsement (Form UIIE-1 or C equivalent) is part of the auto policy(ies). The attached list of providers are additional insureds in regards to the auto liability. Those providers with (*) are additional insureds on the general liability and those with (**) are additional insureds on trailer interchange coverage. OTH- ER E.L. DISESE - E EMPLOYEE E.L. DISESE - POLICY LIMIT DED/LIMIT DED/LIMIT ,000 TRILER INTERCHNGE PHYSICL DMGE HI-E /01/ /01/2018 LIMIT PER TRILER 50,000 1,000 PER TRILER DED 0 CERTIFICTE HOLDER President The Intermodal ssociation of North merica Beltsville Drive Suite 1100 Calverton, MD CNCELLTION SHOULD NY OF THE BOVE DESCRIBED POLICIES BE CNCELLED BEFORE THE EXPIRTION DTE THEREOF, NOTICE WILL BE DELIVERED IN CCORDNCE WITH THE POLICY PROVISIONS. UTHORIZED REPRESENTTIVE - I CORD 22 (2016/03) CORD CORPORTION. ll rights reserved.
4 Page 2 of 3 THIS FORM IS SCHEDULE TO CORD FORM, CORD CERTIFICTE OF INSURNCE To follow are additional insurance policies for the insured shown on the accord certificate: No other additional policies! No blanket additional insured! Note: In addition to naming the companies indicated below additional insured on uto Liability (if applicable): (*) The companies below indicated with a single asterisk are additional insured on General Liability Policy. (**) The companies below indicated with a double asterisk are additional insured on Cargo and/or Trailer Interchange. Equipment Provider s List C L/ Grimaldi Group/ Inarme(**) NL Singapore Pte. Ltd. PL Co. Pte Ltd(**) BNSF Railway Company Bermuda Container Line Limited CM-CGM (merica) LLC COSCO Shipping Lines Co., Ltd./COSCO Shipping Lines (N), Inc./COSCO Shipping Lines (Europe) GmbH CSX Intermodal Terminals, Inc.(**) Canadian Natl/Illinois Central(VN110194) Canadian Pacific Rwy-US (SOO Line/D&H) Eimskip US, Inc. Evergreen Shipping gency (merica) Corp(**) Hamburg Sud North merica, Inc. Hapag-Lloyd (merica) Inc.(**) Hyundai Merchant Marine, Inc.(**) K-line merica, Inc. (Kawasaki Kisen Kaisha Ltd)(**) MCS Maritime Carrier Shipping LLC(**) MOL (merica), Inc. Maersk Line U.S.. as agent for Maersk Line /S dba Maersk Line/Safmarine/Maersk Domestic/Sealand Matson Navigation Company(**) Matson Navigation Company Of laska LLC Mediterranean Shipping Company S..(**)
5 Page 3 of 3 THIS FORM IS SCHEDULE TO CORD FORM, CORD CERTIFICTE OF INSURNCE Nippon Yusen Kaisha (NYK Line)(**) Norfolk Southern Corporation OOCL (US), Inc. s gent For Orient Overseas Container Line Limited & OOCL (Europe) Limited(**) Ocean Network Express ( North merica), Inc./ Ocean Network Express Pte. Ltd.(**) Pacific International Lines (Pte) Ltd. Tote Maritime Puerto Rico LLC(**) Turkon Container Transp. & Shipping Inc. Union Pacific Railroad Company(**) Virginia Intl Terminals-(Va.Inland Port)(**) Wan Hai Lines Ltd. XPO Stacktrain LLC(**) Yangming Marine Transport(**) Zim mer Integrated Shipping Services Co. LLC(**) MOTOR COMPNY NME: DDRESS:, US PHONE: FX:
INTERMODAL INTERCHANGE CERTIFICATE OF INSURANCE
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