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Policy Number: Nrw PREsl;o T_-_RjaNmL <br />AGENCY CUSTOMER ID - <br />DATE (!AWDDrtyM <br />VEHICLE SCHEDULE :L 'w ON' <br />AGENCY 10/06/2017 <br />CARRIER N <br />Interstate Trans Insurance Broker Inc. AC CODE <br />E EFFEC,TnIvE IfE NAMEDORED%NAL BUS L11,7ES <br />PP C <br />011 INTE AT INC <br />POLICY NUMBER FO 6 /E2 2 /E2'0 17 <br />NW FRMSX0 TERM11TAL <br />1fF;I4Ir'I;= nr:_Qr'PI0TIr'iXI <br />VEHN <br />I YEAR Pwm.-MCI-3500 BODYB S <br />VEHICLE TYPE <br />r 2 <br />0' <br />SY411AGIEZ <br />SYMIAGE CO) s p <br />Y, <br />07 <br />CDL,_ <br />! S <br />2001 mcDEL:-UN1T#58 <br />01 <br />PP Fj SPEC <br />M <br />USLY-11 <br />..V.LN.:3BMKHH3A71S090042 <br />CO IL <br />% <br />CO."' <br />-7- <br />7- <br />GARAGING I S-MEET(Raquinid In" CITY I COUNTY <br />STATE ZP <br />ADDRESS 1140 �-RnslTO <br />STREET k�NTLTRA <br />LIC <br />021 Qq7nCZ <br />37 0 <br />STATE TERR GVW I GCW CLASS sic, ;:ACTOR ISFATOPI RADIUS FARTHESTTERMINAL <br />COST <br />COST NEVJ <br />50,000 CA 033 55 <br />. Boo <br />USE HIRE I CHECK <br />ERAGES <br />14' <br />FA 'L q 0 - U N D RI RENT <br />T <br />P RD "IC MOTOR <br />Mo 0 <br />To <br />FAULT MOTOR F Lj L;SP <br />DEDUCTIBLES <br />S C SPEC <br />ID90,51"REISIP—SIC <br />COMM`LHFOR <br />PLEASURE ,�AJJJL LIAB <br />W11 <br />To ""I — R EIMB <br />_D ING <br />4F &L " go FT PC <br />MEDPAY T&OL'ASOR OTC <br />ACV OTC C SFL <br />AA <br />FARM SERVICE NO <br />FAU rr <br />'N <br />UN INS �.PEC <br />MOTOR OF1 FTW COLL <br />DRIVETO <br />COLL <br />DRICR; <br />TOM PREM: S <br />IIY9'9AR7 <br />.MCI-102X)L3 <br />1JEA"DEL-UNIT02 <br />B)DYB <br />IYPE* US <br />VEHICLE TYPE ISYMIAGE <br />C OMPI <br />OTCSYM <br />DIX <br />v.ix:1M8PDMTA8VP049Z_31 ::� <br />Ov2EHO <br />= 17 <br />SYM <br />PP SPEC X1 COML <br />7- <br />7 <br />7 -- <br />GARAGING STREBT(RaquImdInKY) <br />CITY <br />COUNTY <br />STATE <br />- <br />ZiP <br />ADDRESS SAME <br />ATE <br />STATEI... <br />TERR <br />GVW1GCW CLASS <br />150 <br />IC <br />FACTOR <br />SEATCP <br />RADIUS <br />FARTHrSTTERMINAL COST <br />' <br />CA <br />1 <br />56 <br />LD <br />Soo .--- <br />BE $ <br />RE: _S COMP/ <br />DEDUCTIBLES cc h" SPEC <br />SPEC <br />USE <br />_000 <br />_-, FOR HIRE <br />C EC <br />co ERAGES <br />ADD No- <br />FAULT <br />UNDRINS <br />MOTOR <br />F <br />LSP <br />PLEASURE <br />RCO:LIL <br />ri <br />LIAB <br />�MQTQR <br />MEDPAY <br />T <br />&CMANR <br />Fr <br />Co., <br />OTC <br />REIMS ACV OTC _L <br />C COFL <br />re AA STAMT <br />MT <br />FARM <br />SERVICE <br />NO. <br />-illy <br />UNINS <br />SPEC <br />FTW <br />cc <br />S-0- <br />$_o <br />0 <br />S-0- <br />S COLL <br />;TAL <br />DRIVETO_ <br />WORKISCHOOL <br />is MILES 16 MIUES+ E!`Vt� <br />I <br />DRICR <br />: <br />PREM: $ <br />MA" -MCI 102DL3 <br />VEHICLE TYPE S <br />/Arm <br />-C-6ViP_J <br />0 <br />moo - T#75 <br />I w,N.:1M8P1)MPA3TP047819 <br />03 <br />1996 <br />pp PEC �Z] COM <br />.0 <br />-7- <br />BY <br />7- <br />GARAGING STREET (Raqulmd In PM CITY COUNTY <br />STATE MP <br />ADDRESS SAbdE <br />LIC <br />TERR GVT1 I GCW CLASS sic FACTOR RADIUS STATE _.sEArcPP FARTHESTTERMINAL <br />COSTNEW <br />CA 033 50,000 LD 500 <br />R HIRE CHECK <br />USE CK DD' NO. U14DRINS <br />COMM-L " FO F COMP 6 <br />cov DEDUCTIBLES <br />XGES' FAULT MOTOR LP_ FED <br />ACV OTC COFL <br />PLEASURE LIAB MED PAY TOWING FT COMP/ <br />& LABOR OTC 0- <br />AA-, STAMT <br />NO-1 <br />FARM UNINS SPEC <br />OF <br />JSMILIES+ NMI vull COLL <br />JpfgCHO L is MILES DRIC <br />VEHO YEAR MAXIE:VAN HOOL-T2145 ROD BTJS TOTAL PRE J. S <br />E L ' TYPE S COMP/ <br />VEHICIrTYPE SYMIAGE <br />V .. C r AIA OF COLL <br />BY" <br />04 2000 MoDr .uNiT#86 SW4 <br />TELL <br />.L V.LN.:Yr.2TC12B6Y2043949 <br />SPECCC L <br />pp SPEC COML 7- 7- <br />7- <br />GARAGING <br />STREET (Requlmd In" <br />CITY, <br />COUNTY <br />COUNTY <br />ADDRESS <br />SANIE I <br />STATE <br />STATE <br />ZIP <br />Zip <br />O <br />STATE <br />1033 <br />TERR <br />150, <br />Gvw I Cow <br />CLASS <br />1 <br />sic <br />FACTOR <br />sSATcp <br />RADIUS <br />I EM <br />FARTHESTIERMINAL <br />COSTNLTW <br />NL V <br />CA <br />000 <br />62 <br />00 <br />- N RI COMP/ <br />USE COM%VL HA G UNDRINS r LSP DEDUCTIBLES COMP/ SPEC <br />�T .. <br />FOR HIRE CHECK ARAUDLLTNO MOTOR S S E <br />EE INMT3 ACV OTC C OF L <br />C �L <br />R CrFL <br />RETAIL 3 FT COMPI 18 <br />, At <br />PLEASUREM ED PAY, TOWNG J.G <br />X LIA OTC <br />& LVABOR' <br />2� <br />AA ST AMT <br />FARM NO UNINS P5, <br />SPEC SERVICE <br />rTW COLL <br />MOTOR *-o- <br />DRIVE To 15 MILES 15 MILES + NETVF_H COLL <br />WORKISCH <br />TOTAL PREM: S <br />VPH 4 YEAR <br />—11 <br />t.-I-mvp <br />SYM co"'I" COLL <br />[Fn:VMHO0L-T2145 <br />X2_� VEHICLE TYPE COLL <br />05 1999 L.UNIT#90 _7 <br />OE OTC sy" 7� <br />JOI)v I - OTC SYM SYM <br />1 I P7/n <br />:YE=-�6:�3B20�432 PP <br />V.LN. 0 SPEC COIAL 7- 7 <br />I 7- 7- <br />GARAGING <br />MEET (Requlmd In KY) <br />CITY <br />CITY <br />COUNTY <br />COUNTY <br />ADDRESS <br />I SAtdE <br />STATE <br />STATE <br />Zip <br />ATE <br />TERR <br />150,000 <br />GVW I GcW CLASS <br />CLASS <br />SIC <br />FACTOR <br />SFATCP <br />RADIUS <br />'U' <br />FARTHESTTERMINAL <br />OOSTNEW <br />OF .TN.v,r <br />CA <br />033 <br />5 <br />-5oo <br />goo <br />$ <br />USE <br />COMMIL FOR <br />RAGES <br />ADD1 NO- S LSp RRENT <br />0' UN ...... <br />FAULT MOTOR LSP <br />AMIA <br />nr <br />DEDUCTIBLES SPEC <br />PLEASURE <br />RETAIL <br />LLAB <br />I J" <br />REJMB <br />TOWING FT COMPJ� G <br />MED PAY P, HFG <br />V OTC COFL <br />FARM <br />SERVICE <br />NO- <br />LABOR rlTrl. <br />0, <br />UNINS SPEC <br />11 <br />aT COLL <br />COLL <br />TOM PREM: $ <br />D74TOCgOoL 1-15��ASMLES+ I NETV9H <br />�WQ_PKIS DR/Cg: <br />At'r%MM 4')o ')INnO14.4 <br />'Z luz"'3_Awuu AtuK'J L;uKI'UKA_FIQN- All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />toad 11sina Forms Bos% plus saftare. 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