DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 4/29/2024
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).
CONTACT
PRODUCER
NAME: Santa Obregon
Orbis Insurance Group LLC PHONE FAX
7500 NW 52nd St. (A/C, No, Ext): 786-406-1400 (A/C, No): 786-693-8523
E-MAIL
Ste. 100 ADDRESS: coirequest@orbisinsurancegroup.com
Miami FL 33166 INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Trisura Specialty Insurance Company Inc. 16188
ANDOTRU-01
INSURED INSURER B : Great Lakes Insurance SE 134004
Andoba Trucking Inc
881 W 48th St INSURER C :
Hialeah FL 33012 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 477879418 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
A X COMMERCIAL GENERAL LIABILITY FOP104242023 5/11/2023 5/11/2024 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY PRO-
JECT LOC PRODUCTS - COMP/OP AGG $ 1,000,000
OTHER: $
A COMBINED SINGLE LIMIT $ 1,000,000
AUTOMOBILE LIABILITY FOP104242023 5/11/2023 5/11/2024 (Ea accident)
ANY AUTO BODILY INJURY (Per person) $
OWNED
AUTOS ONLY
X SCHEDULED
AUTOS
BODILY INJURY (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
X PIP $10,000 $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
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 $
B Motor Truck Cargo D231225/105 5/11/2023 5/11/2024 $100,000 $1,000 deductible
Reefer Breakdown $2,500 deductible
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
2019 KW 1XKYD49X7KJ279253
2012 FRHT 1FUJGLBG3CSBM1953
2013 FRHT 3AKJGLBGXDSFH1197
2009 FRHT 1FUJGLCK09LAF0284
2015 FRHT 3AKJGLD59FSFK4441
2017 VOLV 4V4NC9EH3HN994534
2017 FRHT 3AKJGLDR4HSJA6867
2007 FRHT 1FUJBBCK07LX04188
See Attached...
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.
Kodiak Transportation LLC
PO Box 3479 AUTHORIZED REPRESENTATIVE
Englewood CO 80155
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: ANDOTRU-01
LOC #:
ADDITIONAL REMARKS SCHEDULE Page 1 of 2
AGENCY NAMED INSURED
Orbis Insurance Group LLC Andoba Trucking Inc
881 W 48th St
POLICY NUMBER Hialeah FL 33012
CARRIER NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
2005 FRHT 1FUJA6CKX5LU20588
2012 FRHT 1FUJGLBG3CSBM1645
2005 FRHT 1FUJAPCK85DN58081
2013 FRHT 1FUJGLDR8DSBX3765
2003 FRHT 1FUJA6CG43LH34653
2009 PTRB 1XPHDB9X89D7800305
2007 FRHT 1FUJA6CK07DY80968
2016 PTRB 1XPBD49X6GD325984
2013 FRHT 3AKJGLBG5DSBU1078
2013 FRHT 1FUJGLBG9DLFH6161
2017 INTL 3HSDJAPR2HN694662
2014 VOLV 4V4NC9EH2NE166034
2006 FRHT 1FUJA6CK96LX02240
2012 VOLV 4V4NC9TH3CN561551
2007 VOLV 4V4NC9TH87N423560
2009 FRHT 1FUJA6CK99DAC5543
2013 PTRB 1XP4D49X4DD190752
2014 FRHT 3AKJGLD51ESFJ1584
2011 VOLV 4V4NC9EJ9BN52985
2005 FRHT 1FUJBBCG55LN22074
2012 MACK 1M1AW09YXCM019504
2011 FRHT 1FUJGLDR1BSAS0528
2005 FRHT 1FUJAPCK25DU00349
2010 FRHT 1FUJGLDR7ALAP1086
2018 Volvo 4V4NC9EH5JN989003
2017 Volvo 4V4NC9EG6HN988993
2004 FRHT 1FUJBBCG44LM05441
2013 KW 1XKAA49Z1DJ288124
Drivers:
Oscar Tamajon
Manuel Rubio
Agustin Montero
Carlos Yedin
Michel Rodriguez
Rodolfo Diaz
Francisco Valerio
Lazaro Izquierdo
David Castillo
Leandro Cabrera
David Regalado
Jose Gonzalez
Omar Mirabal
Yoanny Carbajal
Yoandy Arce
Roybel Pita
Jose Ramon Padron
Eugenio Marrero
Yoel Vega
Guillermo Rivera
Jose Atianza
Karel Denis
Miguel Angel Bernal
Yonel Vega
Asney Aguila
Daniel Jesus Melo
Yoandry Delgado
Duniester Calana Rodriguez
Jose Antonio Azahares
Yerandy Ruiz
Angel Martin Molina
Yeimar Torres
Lazaro Rodriguez Gil
Maxie Coronado
Yosiel Sanchez
Armando Ramirez
Justo Mir Alvarez
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: ANDOTRU-01
LOC #:
ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY NAMED INSURED
Orbis Insurance Group LLC Andoba Trucking Inc
881 W 48th St
POLICY NUMBER Hialeah FL 33012
CARRIER NAIC CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
Lazaro J Viana
Miguel Linares
Osley Espinosa
Karel Rosabal
Alexander Acuna Ramirez
Arolfo Antonio Acosta Sosa
Humberto De Jesus Perez Gali
Jorge Luis Gonzalez Perez
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
