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CERTIFICATE OF INSURANCE
BROKER
DATE: February 28) 2011
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Thiscertificateis issuedas a matterofinformationonlyandconfersnorights
uponthecertificateholder.Thiscertificatedoesnotamend,extendoralterthe
coverageaffordedbythepoliciesbelow
DAL TON TIMMIS INSURANCE GROUP
35 Stonechurch Rd., Ancaster, ON L9K I S5
r.o. Box 2019, Hamilton, ON L9N 3S4
Phone (905-648-3922) Fax (905-648-2640)
Insured:
Outer Limits Transportation
1535 Snyder's
Road E.
Box 152
Petersburg,
ON NOB 2HO
COMPANIES
COMPANY
A
AFFORDING
Sovereign
COVERAGE
General Ins. Company
COMPANYB
Inc.
COMPANYC
r.o.
COVERAGES
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.
POLICY
co
POLICY
TYPE OF INSURANCE
POLICY
LIMITS
EFFECTIVE
DATE
EXPIRATION
NUMBER
CANADIAN FUNDS
(YYIMMlDD)
DATE
(YYIMMlDD)
Eachoccurrence
$2,000,000
GENERAL LIABILITY
A
Generalaggregate
Commercial General
$2,000,000
March 2, 2012
March 2, 2011
BGC062
Products-comp/op $
Liability
agg
o Claims made basis
Personalinjury
$
!RI Occurrence basis
Tenant's legal
$100,000
!RI Tenant's legal liability
liability
~ Non-owned auto
Med Expenseany
$
one person
Non-Owned
$2,000,000
Bodilyinjury &
$2,000,000
AUTOMOBILE
A
propertydamage
LIABILITY
March 2,2012
March 2, 2011
TCA9801748
combined
o Described Automobiles
Bodilyinjury
$
(per person)
(g] All Owned Autos
Bodilyinjury
(g] Leased Automobiles
$
(peraceident)
o Non-owned Automobile
PropertyDamage
$
OTHER:
A
$200,000 Limit, $10,000 Ded.
March 2, 2012
March 2, 2011
Motor Truck Cargo
BGC062
Board Form
All PerilsMarch 2, 2012
Heavy Comm.lTrailers
March 2, 2011
TCA9801748
$10,000 Deductible
Light Commercial Veh.s
$2,500 Deductible
OPCF 2IB
- Blanket Fleet End.
OPCF 27b
$40,000 Limit, $2,500 Ded.
- Non Owned Trailers
DESCRIPTION OF OPERATIONS/AUTOMOBILES/SPECIALITEMS
ADDITIONAL INSURED: N/A
Common Carrier
CANCELLATION
CERTIFICATE
HOLDER
Shouldany of the abovedescribedpoliciesbe cancelledbeforethe expirationdate
Outer Limits Transportation Inc.
thereof,the issuingcompanywill endeavourto mail 15 dayswrittennoticeto the
1535 Snyder's Rd. E. r.o. Box 152
certificateholdernamedto the left,but failureto mailsuch noticeshall imposeno
obligationor liabilityof any kinduponthe company,itsagentsor representatives.
Petersburg, ON NOB 2HO
DALTONTlMMIS INSURANCEGROUP, INe
~
~
PER: Tina Van Dalen, Authorized Representative
1535 Snyder Road East
r.o. Box 152
r~
"Proud of this load cause it's yours!"
Petersburg, ON NOB 2HO
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Tel: (519) 804-6887
Fax: (519) 634-8908
tse.
Name and MailingAddress I Nom e{ adresse posta/e
OUTER LIMITS TRANSPORTATION
40 WINORUSHTRAIL
KITCHENER ON N2P 2A8
"
The CVOR Certificate or a true copy must be surrendered
demand of a police officer. Not to do so Is an offence.
on
Le certlflcat d'lmmatriculatlon
UVU ou utie cople con forme de celul-cl
doit ~tre presente
ragent de police qui en fait la demande.
Qulconque ne respecte pas cette directive commet une Infraction.
e
INC.
1IIIIIIIIIi
11111111111111111111111111111111111111
00437252
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Detach here I Detachez icl
Pr~Vllice
@)antario
of Ontario
provif/~e iferOntarlo'
is~~ed~J;8u~~tIO.thIiHI!lhW~YTr~ffl~.A~I'ID6I1Vt8&/Iverl\lifu,c<id6d~/8.~'
Commercial
Vehicle
".
Operator's
Registration
Cerlificale
d'uliUsaleur de vehicule utilitaire
Certifical d'lmmalriculalioo
Commercial Vehlels operator's
A~glsii'atjon No.,
"
fr, ci'lni;;Wl'fc~/atlon
ae vehibuie
166~79g':462,
ci"Ulliisateur
For replacement, correction or Information change, complete and
submit a new CVOR application form to: Ministry of Transportation.
Carrier Sanctions & Investigation Office, 301 St. Paul St. 3rd floor.
Catharines, On l2R 7R4.
st
uUlitslra
Name I Nom,
This certificate or a true copy must be carried 10 each oommerclal
motor vehicle being operated under the Commercial Vehicle
Operator's Registration.
~;~)i
Ce certlflcat ou une cople conforme dolt se trouver dens cheque
vehlcule utllltalre exploite sous couvert de rlmmatrlculatlon
d'utlllsateur de vehicule utI/ltalre.
OUTER LIKlf~TRANSPORtATIONINC"
!SlJue D(liei D;t(lcJed~IIm.;;oe
.": .1-i
Y/A
'M,DIJ
'
Pour falre remplacement votre certlflcat ou pour y apporter des
corrections, completez et envoyez un nouveau formula Ire de
demande dlmmatriculatlon
dutlllsateur de vehlcule utllltalra, au :
Mlnlstere des Transports, Bureau des sanctIons et des enqu~tes
concernant tes trsnsooneurs, 301, rua SI. Paul, 3e Blage,
St. Catharines (Ontario) L2R 7R4.
SR·LH·123 06·02
00437252
/1ul7ks
erctd
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1535 Snyder Road East
P.O. Box 152
Petersburg, Ontario NOB 2HO\
Tel: (519)804-6887
· llClC1m6YfPfiJClllC11l0fiJm omma
"Proud of this load cause its yours!"
Fax: (519)634-8908
www.outerlimitstrans.com
CREDIT APPLICATION
General Information:
Company Name:
_
legal Name:
Address:
City:
Telephone:
Accounts Payable Contact:
Ernail address for Payables:
FORM OF BUSINESS: Sole Proprietor:
HST NO.:
. Prov/State:
.. Fax:
_~
__
Postal:
Partnership
_
_
Corp:
_0
_
Years in Busmess:
Ownership Information:
Prinicipal Owners Name:
Partner/Officers Name: _____________
.;.. "'nt:e:
Title::
_
_
Bank Information:
Name of Bank:
_
Address:
Account #:
Fax#:
Contact:
Phone #
_
Trade References
Company:
Address:
City:
Telephone:
_
_
~
_
.'
Prov/State:
Postal Code:
-'~'~'~'~7\-.-------------
Company:
_
Fax:
_
--
Address:
City:
Telephone:
_
Prov/State:
-'_
___,-------------------------Postal Code:
Fax: __
_
~
____:_-----
Company:
Address:
_
_
City:
Telephone:
Prov/State:
_
Postal Code:
_
Fax:
_
We acknowledge that credit terms granted by Outer Umits Transportation, are net 30 days with applicable finance charge of 2% per month on
outstanding balances over 30 days. Applicant agrees to pay all collection fees, including court costs and attorney fees on a solicitor and his own
client basis should this account be placed in collection at any time for any reason. No oral agreement willbe accepted. The undersigned
certifies the above information to be true, correct and that they are in agreement of our terms. The undersigned hereby authorized Outer
LimitsTransportation to obtain and exchange credit and financial information to assist in their decision to approve and maintain this application
for credit.
Authorized Signature
TItle,
_
Date.__
---..:
_
Pleasefax completed application to 519-634-8908 Attention: Credit Manager
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