Quote Summary Page

Quote ref: AZBXUZ

Insured Information

Insured Name FJY TRUCKING INC

Address 755 VALLEJO DR
City, State, Zip ROCKWALL, TX, 75087
Effective Date 5/1/2024
Expiration date 5/1/2025
Auto Physical Damage

Paper Company- Firemen's Fund Indemnity Corporation

Auto Physical Damage per Vehicle Limit $0
Auto Physical Damage per Occurence Limit $0
Auto Physical Damage Deductible $0

Motor Truck Cargo

Fireman's Fund Indemnity Corporation

Motor Truck Cargo per Vehicle Limit $ 100
Motor Truck Cargo per Occurrence Limit $ 100
Motor Truck Cargo Deductible $ 100
Table 4

APD MTC
TIV $0 $ 100
Rate $0 $ 2,500
Flat Chargers $0 $0
Proposed Premium $0 $0

Additional Coverages Limit

Debris Removal $ 25,000
Earned Freight $ 25,000
Newly Acquired Terminals Coverage $ 250,000
Cargo Extra Expenses $ 15,000
Rewards Coverage $ 5,000
Contractual Penalties $ 5,000
Fire Department Service Charge $ 15,000
Pollutant Cleanup and Removal $ 25,000

Supplemental Coverages Limit

Moving Equipment Coverage $ 10,000
Spare Parts Coverage $ 5,000
On Board Electronics Coverage $ 10,000
Off Board Electronics $ 10,000
Your Merchandise $ 25,000
This Quote is subject to the following Conditions:

This quote may be withdrawn at any time prior to acceptance and in no event will it remain open beyond 30 days or the effective date,
whichever comes first.
This quote is not a binder of insurance. Coverage cannot be considered bound without our written consent.

Receipt of the completed AND signed Surplus Lines Tax Filing Confirmation form warranting that the broker/agent will accept full
responsibility for compliance of the Surplus Lines laws AND the collection AND remittance of the applicable surplus lines tax AND/OR

This document was issued on: 5/1/2024 Quote Ref: AZBXUZ Agency Details: Aventum Group

Page 1 of 5
 stamping fees on 100% of the premium, must be RECEIVED within 10 days of binding. IF the Surplus Lines Filing Confirmation form is
NOT RECEIVED within 10 days, we reserve the RIGHT to cancel the binder AND/OR any policy issued in connection with the binder.

This quote is strictly conditioned upon no material change in information provided to us. In the event of such change in the exposure OR
conditions, we may (at our sole discretion AND whether this quote has already been accepted by the Assured) modify AND/OR
withdraw this quote.
Review this quote carefully as the limits, coverage(s) AND other terms AND conditions may vary significantly from those initially
requested in your submission.
This quote contains only a general description of the coverage provided. For a detailed description of the terms of the policy, you must
refer to the specific policy form AND endorsements indicated.
Satisfactory Company inspection AND compliance with recommendations deemed essential by the Company.
Any applicable state surcharges/taxes and fees are in addition to the indicated premiums.

***********SURPLUS LINES NOTICE ***********

The coverage as stated above is being bound on a surplus lines-non admitted basis. As a condition of binding the above coverage, the
broker/agent warrants the following:
1. 1. The broker/agent holds the surplus lines license in the state where coverage will be provided to the Insured and accepts the full
obligation to comply with each state's surplus lines laws and regulations in conjunction with this transaction.
2. 2. The broker/agent accepts full responsibility for compliance, including but not limited to the filing of the surplus lines affidavit (as per the
state's requirements), and the collection and remittance of the surplus lines tax and any applicable stamping fee on 100% of the premium
of this policy. The broker/agent's acceptance of these requirements is to be confirmed by completing, signing and dating the attached
Surplus Lines Filings Confirmation form.

Form
Form Name
Number
AGCS Policy Jacket Letter 99 01 19
IM TOC
Inland Marine Table of Contents
01 10
TRANS
Mandatory Premium Transaction Form
DEC 01 05

Policy Holder Notices

Policyholder Notice-United States Department of Treasury
OFAC
Office of Foreign Assets Control (“OFAC”) 1005 PHN
11 11
PVCYV5C
Privacy Notice
01 24 CA

IM 1000
Inland Marine General Declarations
DEC 07 14
OFAC
OFAC Endorsement
1000 11 11
IM 8035
Electronic Data Exclusion Endorsement
12 20
IM 8002
Fungi Limitation Endorsement
01 10
IM 8006
Virus, Bacterium, or Other Microorganism Exclusions
03 20

SLP 4601
Specialty Logistics Package Motor Truck Cargo Declarations
DEC 10 14
SLP 4621
Specialty Logistics Package-Motor Truck Cargo Coverage Form
10 14
SLP 4649
Specialty Logistics Package-Reporting Endorsement
10 14

This document was issued on: 5/1/2024 Quote Ref: AZBXUZ Agency Details: Aventum Group

Page 2 of 5
 MTC 4326
Motor Truck Cargo Waiver of Deductible Endorsement
09 21

TER 9001
Certified Acts of Terrorism Exclusion
01 24
TER 9005
Certified Acts of Terrorism Coverage
01 24
TER 9015
Important Notice Regarding Terrorism Coverage-
PHN 01 24

Additional Coverages Limit

See
Newly Acquired Vehicles Coverage Reporting
Conditions
Towing, Debris Removal and Storage Coverage $ 25,000
Reward Coverage $ 5,000
$ 150 per
Rental Costs Reimbursement Coverage
Day
$ 5,000
Any One
“Loss”

Reporting Conditions
Premium
Report
Premium Base Adjustment
Period
Period
☐
☒ Other -Total Insurable Values ☐ Monthly
Monthly
☒ ☐
Quarterly Quarterly
☒
☐ Annually
Annually
This Quote is subject to the following Conditions:
1. This quote may be withdrawn at any time prior to acceptance and in no event will it remain open beyond 30 days or the effective date,
whichever comes first.
2. This quote is not a binder of insurance. Coverage cannot be considered bound without our written consent
3. Receipt of the completed and signed Surplus Lines Tax Filing Confirmation form warranting that the broker/agent will accept full
responsibility for compliance of the Surplus Lines laws and the collection and remittance of the applicable surplus lines tax and/or
stamping fees on 100% of the premium, must be received within 10 days of binding. If the Surplus Lines Filing Confirmation form is not
received within 10 days, we reserve the right to cancel the binder and/or any policy issued in connection with the binder.
4. This quote is strictly conditioned upon no material change in information provided to us. In the event of such change in the exposure or
conditions, we may (at our sole discretion and whether this quote has already been accepted by the Assured) modify and/or withdraw
this quote.
5. Review this quote carefully as the limits, coverage(s) and other terms and conditions may vary significantly from those initially requested
in your submission.
6. This quote contains only a general description of the coverage provided. For a detailed description of the terms of the policy, you must
refer to the specific policy form and endorsements indicated.
7. Satisfactory Company inspection and compliance with recommendations deemed essential by the Company.
8. Any applicable state surcharges/taxes and fees are in addition to the indicated premiums.
9. There is no Coverage for Vehicles listed on the provided Schedule of units, unless a value was indicated next to the unit.
10. This Quote is subject to also binding the accompanying Motor Truck Cargo quote. We would decline to offer this quote on its own.

***********SURPLUS LINES NOTICE ***********

The coverage as stated above is being bound on a surplus lines-non admitted basis. As a condition of binding the above coverage, the
broker/agent warrants the following:

This document was issued on: 5/1/2024 Quote Ref: AZBXUZ Agency Details: Aventum Group

Page 3 of 5
 1. The broker/agent holds the surplus lines license in the state where coverage will be provided to the Insured and accepts the full obligation
to comply with each state's surplus lines laws and regulations in conjunction with this transaction.

2. The broker/agent accepts full responsibility for compliance, including but not limited to, the filing of the surplus lines affidavit (as per the
state's requirements), and the collection and remittance of the surplus lines tax and any applicable stamping fee on 100% of the premium
of this policy. The broker/agent's acceptance of these requirements is to be confirmed by completing, signing and dating the attached
Surplus Lines Filings Confirmation form.

Form
Form Name
Number

AGCS Policy Jacket Letter 99 01 19

IM TOC
Inland Marine Table of Contents
01 24
TRANS
Mandatory Premium Transaction Form
DEC 01 05

Policy Holder Notices

Policyholder Notice-United States Department of Treasury
OFAC
Office of Foreign Assets Control (“OFAC”) 1005 PHN
11 11
PVCYV5C
Privacy Notice
01 24 CA

IM 1000
Inland Marine General Declarations
DEC 01 24
OFAC
OFAC Endorsement
1000 01 24
IM 8035
Electronic Data Exclusion Endorsement
01 24
IM 8002
Fungi Limitation Endorsement
01 24
IM 8006
Virus, Bacterium, or Other Microorganism Exclusions
01 24

SLP 4602
Specialty Logistics Package-Auto Physical Damage Declarations
DEC 01 24
SLP 4622
Speciality Logistics Package-Auto Physical Damage Coverage From
01 24
SLP 4649
Specialty Logistics Package-Reporting Endorsement
01 14
SLP 4649
Specialty Logistics Package-Reporting Endorsement
01 14

Terrorism Non-Admitted
TER 9001
Cetified Acts of Terrorism Exclusion
01 24
TER 9005
Cetified Acts of Terrorism Coverage
01 24
TER 9015
Important Notice Regarding Terrorism Coverage-
PHN 01 24
SLP 4649
Specialty Logistics Package-Reporting Endorsement
01 14

Terrorism Non-Admitted

This document was issued on: 5/1/2024 Quote Ref: AZBXUZ Agency Details: Aventum Group

Page 4 of 5
 TER 9001
Cetified Acts of Terrorism Exclusion
01 24
TER 9005
Cetified Acts of Terrorism Coverage
01 24
TER 9015
Important Notice Regarding Terrorism Coverage-
PHN 01 24

This document was issued on: 5/1/2024 Quote Ref: AZBXUZ Agency Details: Aventum Group

Page 5 of 5