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Policy Number Izr EMSHO THPIC„IAL <br />AGENCY CUSTOMER ID: <br />lv'VEHICLE SCHEDULE Q;` 2W T'y' <br />AGENCY CARRIER HAIG CODE <br />Interstate Trans Insz=ance Broker Inc. <br />POLICYNWSER EFFEC NEGATE NAMED��sstuRE <br />NWVRESx0 TEiocauT 06/22/2017 iNTEk�NA.T'%NAL BUS LINES INC <br />VEND YEAR MAKE:VOLVO <br />wpgl S <br />VEHICLE sYM/aGE <br />OTc <br />v.LNa3CZT2V226G5472808 <br />016 2016 HoDEL: #1058 <br />PP SPEC�Zj COML <br />GARAGNG <br />SYREET(Raq:dmdMKY) <br />CnY <br />COUNTY <br />sTATB <br />YIP <br />ADDS <br />STREET <br />SNQ <br />IRA <br />: A <br />37Q6 <br />STATE <br />1033 <br />7F3iR <br />j,,00Q,vWjGMCLASS <br />SIC <br />FACTOR <br />SEATCp <br />RADIUS <br />FARTHESTTERMENAL <br />co"KM <br />CA <br />0 <br />00 <br />$ <br />USE COWL FOR HIRE C <br />q�pppp�� <br />FAULTN0- B F L8P �� <br />DEDUCnBIEBAOV <br />PLEASURE RETAIL 7ES <br />TkplOyT{�OlT <br />MEDPAY S &NGF7 CcOTCompt FG <br />C OF L <br />AA STAhrr S5QQQ <br />FARM SERVICE <br />UW113 FTW COLL <br />$300OOO Isscoo COLL <br />1SMILE8+ ETA <br />RIC COL.<iSMILFS <br />TOTALPREM- S <br />VENS <br />YEAR I MAKMXCI <br />BVS <br />VEHICLE Type SYMIAGE <br />OTCsYAt! <br />COIy <br />SYht <br />vjA:UaXvDMRA.7WP050825 <br />03.7 <br />1998 1 Iuoneu <br />PP 17 SPEC COME <br />GARAGING <br />STREET (Rogalmd In KYj <br />CTIY <br />COUNTY <br />STATE <br />YIP <br />ADDRESS <br />TSRR <br />GVWIGCW <br />CLASS <br />SIC <br />FACTOR <br />SEATCP <br />RADIUS <br />FAR7HESTTERMINAL <br />COSTNEW <br />�O <br />$ <br />USE <br />CCWLHFORHIRE <br />COVERAGES ECK <br />PA&NO- <br />u� <br />MO01O�R <br />F <br />L&P <br />RElMB <br />DE carIBLES ACV <br />CO <br />am <br />PLEASURE <br />RETAIL <br />LAB <br />MED PAY <br />�P <br />Ff <br />OC P! <br />FG <br />AA STAMT <br />C <br />C L <br />S00 <br />FARM <br />SERVICE <br />FTW <br />COLL <br />:d$00 <br />- <br />$OO <br />!-DrAVET <br /><16M1LE8 1bINiLE8+ DWORs <br />TOTALPREM: S <br />VM0 <br />YEAR <br />MAKEwr <br />VMMETYPE SYMIAGE <br />OTC <br />MOWL: <br />VJA: I <br />IPP F1 SPEC COML <br />Sm <br />GARAGING <br />STREET(RegalmdlnKY) <br />CITY <br />COUNTY <br />STATE <br />ZIP <br />ADDRESS <br />IIADstB <br />I <br />8TABTEHR <br />T <br />amIGCW CLASS <br />Sr- FACTOR <br />SEATCP <br />FARTHESTTERMINAL <br />COSTKEW <br />$ <br />USE COMMT. FORHIRE CC EERAGES F�7Na F ' REMB DBDU6118LE8 ACV CO ! <br />�MpOyTyO��Rp FT COMP/ FG QTC OF L <br />PLEASURE RETAIL LIAB ME D PAY <br />LABOR <br />NO- UHINS $ OTC AA BTAOdT S <br />FARM SERVICE FTW COL <br />$ S COLL <br />MILES t8 M11E8+ T <br />.MRKISCHOOL<18 <br />7T7TALPREM: $ <br />VEN O YEAR <br />MAKE: VEHICLE TYPE B WAGE oTO BYM <br />MODl3: V.LN.: PP SPEC COME <br />GARAGING <br />STREET(Rtigcdmd to KY) <br />CITY <br />COUNTY <br />ADDRESS <br />8TAT'@ <br />ZIP <br />STAis <br />TERR <br />GVWlGgY <br />CLASS <br />SIC FACTOR <br />SEATCP <br />RADIUS <br />FARTHFSTTERMSULL <br />COSTNEW <br />$ <br />A ULTNOD NM <br />OMPJ <br />USE COLOrpL FOR HERE C F.8 CRMXAFADULT MUOrOR NS F LSP REIMB DEDUCTTSLEfs�TAM'VT <br />CV <br />PLEASURE RETAIL 6W8 PAY TOWING COMP/ RE COFL <br />AA $ <br />FARM SERVICE NO- LIN SpE R <br />FAULT A FTW COLL <br />$ S <br />TO COLT <br />DOL<iBMiLEB tSM1LE8+ VEH <br />VE}f 0 YEAR MA143s Bogy TOT REM: $ <br />VEt TYPE SYMIAGB OTc <br />MODEL V.m PP SPEC COML <br />GARAGING <br />6'RmT(R°gnlmdlnKY) <br />CITY <br />COUNTY <br />ADDRESS <br />STATE <br />xIP <br />STATE <br />YERR <br />OVWlGCW <br />CLASS <br />SIC <br />FACTOR <br />[7CPI <br />MILis <br />PARTNESTTERMINAL <br />COSTNEW <br />USE COMML FOR HIRE RAGES PULL NO•HjN8 F LSP <br />FAULTR LSP(Inv <br />DE�JCTIBLFS <br />RRETMS <br />PLEASURE RETAIL LIAR MlB7 PAYG FT �GMP! FIB <br />ACV OTC 0 L <br />FARM 8ERVICE Na UNINS°R <br />AA STAMT $ <br />PTW <br />[dVs <i6 MELEE 1S MILES+ NET <br />s $ COLL. <br />TOTAL PRFM: $ <br />ACORD 129l200WIII__ ____ _ _ ___._ _ <br />- Tnaa zuuy ACORD CORPORATION. All r►ghts reserved, <br />The ACORD name and logo are registered marks of ACORD <br />Produced us(na Fcmts Boss Plus sof mre. v wwyormsBo8s.cam: Imuresslve Publishina 800,208-1977 <br />[[-Hy ...E�_ _._...j <br />EUNICE HEREDIA(E7F� J <br />