Pro Black Car

24324 Hartland St
Canoga Park CA 91307
United States
 DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE 11/30/2022

11/23/2022
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 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).
PRODUCER CONTACT
biBERK NAME:
1314 Douglas Street PHONE FAX
Suite 1400 (A/C. No. Ext): 844-472-0967 (A/C. No): 203-654-3613
Omaha NE 68102-1944 E-MAIL
United States ADDRESS: CustomerService@biBERK.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Berkshire Hathaway Direct Insurance Company 10391
INSURED Pro Black Car INSURER B:
24324 Hartland St INSURER C:
Canoga Park CA 91307 INSURER D:
United States INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
CLAIMS-MADE OCCUR MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $

PRO-
POLICY LOC
JECT
$
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE AUTHORITY $ 750,000.00
(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $ N/A

SCHEDULED X
A ALL OWNED X AUTOS
0017376-01-CA 12/01/2022 12/01/2023 BODILY INJURY (Per accident) $ N/A
AUTOS
NON-OWNED PROPERTY DAMAGE
$ N/A
HIRED AUTOS AUTOS (Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LAB CLAIMS-MADE AGGREGATE $

DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS’ LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE N/A
OFFICER/MEMBER EXCLUDED? Y/N E. L. EACH ACCIDENT $
(Mandatory in NH)
E. L. DISEASE – EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E. L. DISEASE – POLICY LIMIT $

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The certificate holder is recorded in the insurer's records as a loss payee for 2022 CHEVROLET SUBURBAN 1GNSCCKDANR311171 with limit of $60700 and a comprehensive deductible of
Red Van Mgmt. Services, INC DBA Shuttle2LAX,, is listed as additional insured as it pertains to auto liability
$500 or if different deductibles: Comprehensive deductible of $2,500.and a collision deductible of $500 or if different deductibles: Collision Deductible of $2,500.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Red Van Mgmt.
Ally Financial Inc. Services, INC EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
500 Woodward
DBA Ave
Shuttle2LAX, POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
P.O. 452600
Detroit MI 48226
Los Angeles, CA 90045

ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD
M-5652 (07/2015)
 M-5171 (07/2010)

SCHEDULE OF COVERED AUTOS

POLICY NUMBER: 0017376-01-CA EFFECTIVE DATE: 12/01/2022

NAMED INSURED: Pro Black Car

NOTES:

VEHICLE INFORMATION:

Use* Garaging GVW or Seating

Year Make and Model VIN Radius Garaging City, State
(C/S/R) Territory Cap.

Personal Injury Protection

Vehicle # Liability Premium Medical Payments Premium Additional Insured Premium In-Tow Premium Cargo Premium
Premium

Stated Limit Specified Causes (S) or Specified Causes or Specified Causes or

Collision Premium Collision Deductible
or ACV Comprehensive (C) Comprehensive Premium Comprehensive Deductible

Canoga Park
2022 CHEVROLET SUBURBAN 1GNSCCKDANR311171 50 10000
CA

1 $4,958.00 $91.00 $0.00 $0.00 $0.00 $0.00

ACV C $662.00 $2500 $2,776.00 $2500

M-5171 (07/2010)
Pro Black Car
24324 Hartland St
Canoga Park CA 91307
United States
 DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE 11/30/2022

11/23/2022
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 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).
PRODUCER CONTACT
biBERK NAME:
1314 Douglas Street PHONE FAX
Suite 1400 (A/C. No. Ext): 844-472-0967 (A/C. No): 203-654-3613
Omaha NE 68102-1944 E-MAIL
United States ADDRESS: CustomerService@biBERK.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Berkshire Hathaway Direct Insurance Company 10391
INSURED Pro Black Car INSURER B:
24324 Hartland St INSURER C:
Canoga Park CA 91307 INSURER D:
United States INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
CLAIMS-MADE OCCUR MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $

PRO-
POLICY LOC
JECT
$
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE AUTHORITY $ 750,000.00
(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $ N/A

SCHEDULED X
A ALL OWNED X AUTOS
0017376-01-CA 12/01/2022 12/01/2023 BODILY INJURY (Per accident) $ N/A
AUTOS
NON-OWNED PROPERTY DAMAGE
$ N/A
HIRED AUTOS AUTOS (Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LAB CLAIMS-MADE AGGREGATE $

DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS’ LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE N/A
OFFICER/MEMBER EXCLUDED? Y/N E. L. EACH ACCIDENT $
(Mandatory in NH)
E. L. DISEASE – EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E. L. DISEASE – POLICY LIMIT $

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The certificate holder is recorded in the insurer's records as a loss payee for 2022 CHEVROLET SUBURBAN 1GNSCCKDANR311171 with limit of $60700 and a comprehensive deductible of
Prime Executive Cars DBA Go Sedan, is listed as additional insured as it pertains to auto liability
$500 or if different deductibles: Comprehensive deductible of $2,500.and a collision deductible of $500 or if different deductibles: Collision Deductible of $2,500.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Prime Executive
Ally Financial Inc. Cars EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
500 Woodward
DBA Go Sedan, Ave POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
P.O. 452600
Detroit MI 48226
Los Angeles, CA 90045

ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD
M-5652 (07/2015)
 M-5171 (07/2010)

SCHEDULE OF COVERED AUTOS

POLICY NUMBER: 0017376-01-CA EFFECTIVE DATE: 12/01/2022

NAMED INSURED: Pro Black Car

NOTES:

VEHICLE INFORMATION:

Use* Garaging GVW or Seating

Year Make and Model VIN Radius Garaging City, State
(C/S/R) Territory Cap.

Personal Injury Protection

Vehicle # Liability Premium Medical Payments Premium Additional Insured Premium In-Tow Premium Cargo Premium
Premium

Stated Limit Specified Causes (S) or Specified Causes or Specified Causes or

Collision Premium Collision Deductible
or ACV Comprehensive (C) Comprehensive Premium Comprehensive Deductible

Canoga Park
2022 CHEVROLET SUBURBAN 1GNSCCKDANR311171 50 10000
CA

1 $4,958.00 $91.00 $0.00 $0.00 $0.00 $0.00

ACV C $662.00 $2500 $2,776.00 $2500

M-5171 (07/2010)
Pro Black Car
24324 Hartland St
Canoga Park CA 91307
United States
 DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE 11/23/2022

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 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).
PRODUCER CONTACT
biBERK NAME:
1314 Douglas Street PHONE FAX
Suite 1400 (A/C. No. Ext): 844-472-0967 (A/C. No): 203-654-3613
Omaha NE 68102-1944 E-MAIL
United States ADDRESS: CustomerService@biBERK.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Berkshire Hathaway Direct Insurance Company 10391
INSURED Pro Black Car INSURER B:
24324 Hartland St INSURER C:
Canoga Park CA 91307 INSURER D:
United States INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
CLAIMS-MADE OCCUR MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $

PRO-
POLICY LOC
JECT
$
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE AUTHORITY $ 750,000.00
(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $ N/A

SCHEDULED X
A ALL OWNED X AUTOS
0017376-01-CA 12/01/2022 12/01/2023 BODILY INJURY (Per accident) $ N/A
AUTOS
NON-OWNED PROPERTY DAMAGE
$ N/A
HIRED AUTOS AUTOS (Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LAB CLAIMS-MADE AGGREGATE $

DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS’ LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE N/A
OFFICER/MEMBER EXCLUDED? Y/N E. L. EACH ACCIDENT $
(Mandatory in NH)
E. L. DISEASE – EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E. L. DISEASE – POLICY LIMIT $

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The certificate holder is recorded in the insurer's records as a loss payee for 2022 CHEVROLET SUBURBAN 1GNSCCKDANR311171 with limit of $60700 and a comprehensive deductible of
First Class Transportation DBA Prime Time Shuttle, is listed as additional insured as it pertains to auto liability
$500 or if different deductibles: Comprehensive deductible of $2,500.and a collision deductible of $500 or if different deductibles: Collision Deductible of $2,500.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
First Class Transportation
Ally Financial Inc. EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
500 Woodward
DBA Prime Time Ave Shuttle, POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
P.O. 452600
Detroit MI 48226
Los Angeles, CA 90045

ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD
M-5652 (07/2015)
 M-5171 (07/2010)

SCHEDULE OF COVERED AUTOS

POLICY NUMBER: 0017376-01-CA EFFECTIVE DATE: 12/01/2022

NAMED INSURED: Pro Black Car

NOTES:

VEHICLE INFORMATION:

Use* Garaging GVW or Seating

Year Make and Model VIN Radius Garaging City, State
(C/S/R) Territory Cap.

Personal Injury Protection

Vehicle # Liability Premium Medical Payments Premium Additional Insured Premium In-Tow Premium Cargo Premium
Premium

Stated Limit Specified Causes (S) or Specified Causes or Specified Causes or

Collision Premium Collision Deductible
or ACV Comprehensive (C) Comprehensive Premium Comprehensive Deductible

Canoga Park
2022 CHEVROLET SUBURBAN 1GNSCCKDANR311171 50 10000
CA

1 $4,958.00 $91.00 $0.00 $0.00 $0.00 $0.00

ACV C $662.00 $2500 $2,776.00 $2500

M-5171 (07/2010)
Pro Black Car
24324 Hartland St
Canoga Park CA 91307
United States
 DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE 11/30/2022

11/23/2022
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 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).
PRODUCER CONTACT
biBERK NAME:
1314 Douglas Street PHONE FAX
Suite 1400 (A/C. No. Ext): 844-472-0967 (A/C. No): 203-654-3613
Omaha NE 68102-1944 E-MAIL
United States ADDRESS: CustomerService@biBERK.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Berkshire Hathaway Direct Insurance Company 10391
INSURED Pro Black Car INSURER B:
24324 Hartland St INSURER C:
Canoga Park CA 91307 INSURER D:
United States INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
CLAIMS-MADE OCCUR MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $

PRO-
POLICY LOC
JECT
$
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE AUTHORITY $ 750,000.00
(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $ N/A

SCHEDULED X
A ALL OWNED X AUTOS
0017376-01-CA 12/01/2022 12/01/2023 BODILY INJURY (Per accident) $ N/A
AUTOS
NON-OWNED PROPERTY DAMAGE
$ N/A
HIRED AUTOS AUTOS (Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LAB CLAIMS-MADE AGGREGATE $

DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS’ LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE N/A
OFFICER/MEMBER EXCLUDED? Y/N E. L. EACH ACCIDENT $
(Mandatory in NH)
E. L. DISEASE – EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E. L. DISEASE – POLICY LIMIT $

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The certificate holder is recorded in the insurer's records as a loss payee for 2022 CHEVROLET SUBURBAN 1GNSCCKDANR311171 with limit of $60700 and a comprehensive deductible of
Executive Ride LLC DBA Opoli, is listed as additional insured as it pertains to auto liability
$500 or if different deductibles: Comprehensive deductible of $2,500.and a collision deductible of $500 or if different deductibles: Collision Deductible of $2,500.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Executive Ride
Ally Financial Inc. LLC EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
500 Woodward
DBA Opoli, Ave POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
P.O. 452600
Detroit MI 48226
Los Angeles, CA 90045

ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD
M-5652 (07/2015)
 M-5171 (07/2010)

SCHEDULE OF COVERED AUTOS

POLICY NUMBER: 0017376-01-CA EFFECTIVE DATE: 12/01/2022

NAMED INSURED: Pro Black Car

NOTES:

VEHICLE INFORMATION:

Use* Garaging GVW or Seating

Year Make and Model VIN Radius Garaging City, State
(C/S/R) Territory Cap.

Personal Injury Protection

Vehicle # Liability Premium Medical Payments Premium Additional Insured Premium In-Tow Premium Cargo Premium
Premium

Stated Limit Specified Causes (S) or Specified Causes or Specified Causes or

Collision Premium Collision Deductible
or ACV Comprehensive (C) Comprehensive Premium Comprehensive Deductible

Canoga Park
2022 CHEVROLET SUBURBAN 1GNSCCKDANR311171 50 10000
CA

1 $4,958.00 $91.00 $0.00 $0.00 $0.00 $0.00

ACV C $662.00 $2500 $2,776.00 $2500

M-5171 (07/2010)