Form_SCTNID_CTGRY.XX0316ACORD25_ACORD

<docindex><index>ACORD</index></docindex> BDF_PCA

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

PRODUCER CONTACT 

NAME: 

PHONE 

(A/C, No, Ext): 

FAX 

(A/C, No):

E-MAIL 

ADDRESS: 

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : 

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSR 

LTR

ADDL 

INSD

SUBR TYPE OF INSURANCE WVD

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

OTHER:

PROJECT LOC

AUTOMOBILE LIABILITY

ANY AUTO

OWNED 

AUTOS ONLY

HIRED 

AUTOS ONLY

SCHEDULED 

AUTOS

NON-OWNED 

AUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

DED RETENTION $

WORKERS COMPENSATION 

AND EMPLOYERS' LIABILITY

ANYPROPRIETOR/PARTNER/EXECUTIVE 

OFFICER/MEMBEREXCLUDED?

(Mandatory in NH) 

If yes, describe under 

DESCRIPTION OF OPERATIONS below

Y/N

N / A

POLICY NUMBER POLICY EFF POLICY EXP 

(MM/DD/YYYY) (MM/DD/YYYY) LIMITS

$ 

$ 

$ 

$ 

$ 

$ 

$

EACH OCCURRENCE 

DAMAGE TO RENTED 

MED EXP (Any one person) 

PERSONAL & ADV INJURY 

GENERAL AGGREGATE 

PRODUCTS - COMP/OP AGG 

PREMISES (Ea occurrence) 

$ 

$ 

$ 

$ 

$

COMBINED SINGLE LIMIT 

PROPERTY DAMAGE 

BODILY INJURY (Per person) 

(Ea accident) 

BODILY INJURY (Per accident) 

$ 

$ 

$

AGGREGATE 

EACH OCCURRENCE 

E.L. EACH ACCIDENT 

INSURED

$

$

E.L. DISEASE - POLICY LIMIT $

E.L. DISEASE - EA EMPLOYEE

PER STATUTE OTH- ER

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION

AUTHORIZED REPRESENTATIVE

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

© 1988-2015 ACORD CORPORATION. All rights reserved.

(Per accident) 

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).

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.

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

progressivecommercial@email.progressive.com

09/11/2023

1-800-444-4487

Mark E Rice DBA: M & S Transport 

752 N MAIN ST, UNIT 1418 

MANSFIELD, TX 76063

RV DEPO 

4319 N MAIN ST 

CLEBURNE, TX 76033

Progressive Commercial Lines Customer and Agent Servicing

356549626943461608D091123T180623 

Progressive Insurance 

PO Box 94739, Cleveland, OH 44101

Progressive County Mutual Insurance Company 29203

A N N 08/10/2023 08/10/2024 972215439

See ACORD 101 for additional coverage details. $

Case 23-42473-elm13 Doc 33-1 Filed 09/15/23 Entered 09/15/23 13:39:13 Desc

Exhibit A Page 1 of 2
Form_SCTNID_CTGRY.XX0108ACORD101_ACORD

<docindex><index>ACORD</index></docindex> BDF_PCA

Progressive Insurance

Progressive County Mutual Insurance Company 29203

Mark E Rice DBA: M & S Transport 

752 N MAIN ST, UNIT 1418 

MANSFIELD, TX 76063

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS SCHEDULE Page of 

AGENCY

POLICY NUMBER

CARRIER NAIC CODE

NAMED INSURED

EFFECTIVE DATE:

ADDITIONAL REMARKS

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance

1 1

Description of Location/Vehicles/Special Items

Scheduled autos only

............................................................................................................................................................................................................

Stated Amount 

2014 PETERBILT 388 1NPWD49X9ED241621

$40,000

Comprehensive $500 Ded

Collision $500 Ded ............................................................................................................................................................................................................

Stated Amount 

2014 Cottrell Trailer 5E0AA1443EG560002

$25,000

Comprehensive $500 Ded

Collision $500 Ded ............................................................................................................................................................................................................

Stated Amount 

2014 PETERBILT 388 1NPWD49X4ED241610

$32,000

Comprehensive $500 Ded

Collision $500 Ded ............................................................................................................................................................................................................

Stated Amount 

2014 COTTRELL Trailer 5E0AA1440EG540001

$16,000

Comprehensive $500 Ded

Collision $500 Ded ............................................................................................................................................................................................................

Stated Amount 

2010 PETERBILT 388 1NPWD49X6AD101679

$20,000

Comprehensive $500 Ded

Collision $500 Ded ............................................................................................................................................................................................................

Stated Amount 

2010 COTRELL Trailer 5E0AA1441AG303415

$15,000

Comprehensive $500 Ded

Collision $500 Ded

Liability coverage may not apply to all scheduled vehicles.

Additional Information

RV Depo is the lienholder and loss payee.

ACORD 101 (2008/01) 

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved. 

Case 23-42473-elm13 Doc 33-1 Filed 09/15/23 Entered 09/15/23 13:39:13 Desc

Exhibit A Page 2 of 2