POLIZA DE SEGURO PARA VEHICULO COMERCIAL NO RESIDENTE

NON RESIDENT COMMERCIAL MOTOR VEHICLE POLICY OF INSURANCE

NO OTORGA COBERTURA EN MÉXICO In case of accident report it to the police

EMISION MEXICO and call toll free
En caso de accidente repórtelo a la policía
USDOT MC ENTERPRISE REGISTRATION y llame sin costo INMEDIATAMENTE
1-888-334-0114

POLICY No. : 1031320-1 101277

REPRESENTANTE CAIC: ______________
CERT1204984
Policy Period / Vigencia de la Póliza:
Desde / From: 06 NOV 2017
____________________ 06 NOV 2018
Hasta / To: ____________________ 365
Días / Days: _______________ 12:00AM
Hora / Time:______________

INFORMACION DEL ASEGURADO / INSUREDS INFORMATION

Nombre y Apellido / Name and Last Name Dirección / Mailing Address
1850 LINCOLN AVE SPC 71
IVONNE PADILLA & FRANKLIN PADILLA DBA PADILLA TRANSPORT Ciudad, Estado / City, State Teléfono / Phone
CALEXICO, CA, US 7608794477

DATOS DEL VEHICULO ASEGURADO / VEHICLE INSURED

LA COBERTURA QUE OTORGA ESTA POLIZA NO APLICA A NINGUN VEHICULO QUE THE INSURANCE AFFORDED BY THIS POLICY DOES NOT APPLY TO ANY TRUCK CARRYING OR
TRANSPORTE O REMOLQUE MATERIALES PELIGROSOS SEGÚN EL 49 CFR DEL DOT, HAULING HAZARDOUS MATERIALS ACCORDING TO 49 CFR OF DOT, INCLUDING BUT NOT
INCLUYENDO PERO NO LIMITADO A EXPLOSIVOS, GAS VENENOSO, GAS LICUADO O GAS LIMITED TO:
COMPRIMIDO, MATERIAL RADIOACTIVO, ACEITE, PETROLEO, GAS O GASOLINA, EXPLOSIVES, POISON GAS, LIQUIFIED COMPRESSED GAS OR COMPRESSED GAS, RADIOACTIVE
MATERIAL DE DESPERDICIO, NI A CUALQUIER VEHÍCULO DE TRANSPORTE PUBLICO DE MATERIALS, OIL, PETROLEUM, GASOLINE, HAZARDOUS WASTE, ANY PUBLIC LIVERY VEHICLE
PASAJEROS, VEHICULOS TRANSMIGRANTES AND ALL TRANS IMMIGRANT VEHICLES

CA, CALEXICO
PORT OF ENTRY / PUERTO DE ENTRADA _____________________________________COMMODITIES HAULED / TIPO DE CARGA__________________________________________________________
MERCANCIA GENERAL EN CONTENEDORES (ALFALFA)

AÑO / YEAR MARCA MODELO / MAKE MODEL CATEGORÍA / CATEGORY PLACAS / LICENSE PLATES NÚMERO DE SERIE / VIN NUMBER

2009 FREIGHTLINER CASCADIA TRACTO TRANSFER 1FUJGEDR89LAL7150

REMOLQUE: (EN CASO DE UTILIZAR REMOLQUE DEBERÁ DARSE DE ALTA Y PAGAR LA PRIMA ADICIONAL CORRESPONDIENTE) DAR MISMA INFORMACIÓN QUE EN EL VEHÍCULO PRIMARIO
TOWED VEHICLE (COVERAGE IS ONLY EXTENDED WHEN TOWED VEHICLE IS DECLARED AND EXTRA PREMIUM PAID) SHOW SAME INFORMATION AS FOR COVERED AUTO.

DESCRIPCION DE CONDUCTORES / SCHEDULE OF DRIVERS

Nombre y Apellido / First and Last Name Fecha de Nacimiento / Date of Birth No. Licencia / Drivers license No.

EL SEGURO ES VALIDO PARA CUALQUIER CONDUCTOR ENTRE 21 Y 70 AÑOS CON LICENCIA DE CONDUCIR VIGENTE Y
VALIDA PARA ESTE TIPO DE VEHICULO / THIS COVERAGE IS VALID FOR ANY DRIVER BETWEEN 21 YEARS OLD AND 70
YEARS OLD WITH A VALID DRIVERS LICENSE FOR THIS TYPE OF VEHICLE.
Articulo 1. Las coberturas amparadas en esta póliza de seguro, son específicamente las contratadas y descritas en los ITEM 1. The insurance afforded by this policy is solely with respect to coverages
renglones abajo. El límite máximo de responsabilidad civil que provee la Compañía Aseguradora será el indicado en esta indicated below and where a specific premium charge is indicated.
póliza. Las coberturas amparadas por esta póliza de seguro están sujetas a todas las cláusulas, exclusiones y condiciones de The limit of the insurance company’s liability against such coverages shall be as stated herein.
la póliza de seguro cuya numeración se indica arriba y ampara únicamente al vehículo descrito en el Artículo 3 de esta Coverage is subject to all the terms, exclusions and conditions of the policy referenced by number on this.
misma póliza. Esta Póliza incluye “Términos y Condiciones” en ingles que son entregados por su agente de seguros o This Policy has “Terms & Conditions” which are set forth in the Policy form you may obtain from your agent or at
puede obtenerlos en internet http://www.caicseguros.com/spa/form220.pdf. NOTA: LEA LOS “TERMINOS Y http://www.caicseguros.com/spa/form220.pdf . NOTE: READ THE “TERMS AND CONDITIONS” TO KNOW WHAT
CONDICIONES” PARA QUE SEPA QUE COBERTURA LE ES OTORGADA. SPECIFIC COVERAGE IS BEING PROVIDED TO YOU.

COBERTURAS / COVERAGE LIMITES / LIMITS OF LIABILITY PRIMA / PREMIUM

RESPONSABILIDAD CIVIL DAÑOS A LIMITE COMBINADO BIENES Y PERSONAS
TERCEROS / THIRD PARTY LIABILITY COMBINED LIABILITY BODILY INJURY AND PROPERTY DAMAGE 1,000,000.00 2,351.00

COBERTURAS ADICIONALES / ADDITIONAL COVERAGES (no other coverage provided unless declared here and on FORM AC10 GMO, CAR, PDV, TI 2,997.00
Esta póliza es válida solo para vehículos y/o empresas con operación transfronteriza
ADVERTENCIA / WARNING PRIMA NETA / NET 5,348.00
entre México y los Estados Unidos. La cobertura de este seguro solo aplica en los
PREMIUM
COVERAGE PROVIDED ONLY TO VEHICLES WITH Estados Unidos para los riesgos cubiertos. No hay cobertura en México.
CROSS BORDER OPERATIONS. DERECHO DE
10.00
COBERTURA VÁLIDA PARA VEHÍCULOS CON This policy is valid only for vehicles and organizations with cross border operations POLIZA/
OPERACION TRANSFRONTERIZA. between Mexico and the U.S. Coverage is only provided when vehicle is in the U.S. POLICY FEE
There is no coverage provided to accidents that occur in Mexico.
TOTAL /
5,358.00
TOTAL
Articulo 2 : La cobertura total que ampara esta póliza de seguro, cumple con lo dispuesto por el “Public Law 96-296” fechada el 1 ITEM 2: The total coverage of this policy complies with the Public Law 96-296 dated July 1, 1980, Sections 29 and
de Julio de 1980, Secciones 29 y 30 as amended by the Motor Safety Carrier act of 1984. Endorsement MCS-90 is attached.
30 enmendadas por el “Motor Safety Carrier Act of 1984”. Se adjunta el. Endoso MCS-90. ITEM 3: Insurance afforded hereunder is restricted to the policy period from the effective date and time hereon.
Articulo 3: Las Coberturas amparadas se limitan a un plazo máximo de la vigencia de la póliza, iniciando en la fecha y hora Coverage is valid only in the U.S.A., for trucks and tractor units (including attached semi-trailers) crossing the
indicada. La cobertura cubre y tiene validez únicamente en los E.E.U.U., amparado camiones y tractocamniones (con caja ó border from the Republic of Mexico. COVERAGE IS VALID ONLY up to 250 miles from the port of entry
remolque) que se internan por la frontera provenientes de la República Mexicana. LA COBERTURA ES VALIDA per the authorization to operate granted to the named insured by the USDOT.
UNICAMENTE hasta un máximo de 250 millas a partir del puerto de entrada, de acuerdo a la autorización del USDOT a ITEM 4: “Coverage is also excluded for the following:
la empresa transportista. a) Injury to unauthorized passengers.
Artículo 4: La cobertura excluye: b) Transportation of hazardous, explosives or radioactive materials or substances as defined in CPR 171.8
a) Lesiones corporales a pasajeros no autorizados a transitar en el vehículo asegurado. and 49 CFR 173.403 of the Motor carrier Act of 1980”.
b) El transporte de cargas extremadamente peligrosas, explosivos, materias ó substancias radioactivas, según los Códigos CPR
171.8 y 49 CFR 173.403 del MCA de 1980.

COBERTURA OTORGADA POR

101277
_________________________________
01 NOV 2017 _______________
IVONNE PADILLA & FRANKLIN PADILLA DBA PADILLA TRANSPORT

________________________________________
COMMERCIAL ALLIANCE INSURANCE CO.
415 Lockhaven Dr. Houston, TX 77073
REPRESENTANTE AUTORIZADO FECHA / DATE FIRMA DEL CLIENTE / INSURED’S SIGNATURE NAIC # 10906

Form 150201-MCE
FORM MCS-
MCS-90 Revised 01/05/2017 OMB No.: 2126-
2126-0008 Expiration: 01/31/2020

USDOT Number: Date Received:

A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to
comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a
current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of
information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and
completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection
Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.

United States Department of Transportation

Federal Motor Carrier Safety Administration

Endorsement for Motor Carrier Policies of Insurance for Public

Liability under Sections 29 and 30 of the Motor Carrier Act of 1980

FORM MCS-90
Issued to IVONNE PADILLA & FRANKLIN PADILLA DBA PADILLA TRANSPORT of CALEXICO
(Motor Carrier name) (Motor Carrier state or province)
Dated at 12:00AM on this day of 01 NOV 2017 ,

Amending Policy Number: 1031320-1 Effective Date: 06 NOV 2017

Name of Insurance Company: Commercial Alliance Insurance Company

Countersigned by:
(authorized company representative)

The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one):

[X] This insurance is primary and the company shall not be liable for amounts in excess of $ 1,000,000.00 for each accident.
[ ] This insurance is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the
underlying limit of $ for each accident.

Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a
duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized
representative of the FMCSA , to verify that the policy is in force as of a particular date. The telephone number to call is:
(713) 960-1214
Cancellation of this endorsement may be effected by the company of the insured by giving (1) thirty-five (35) days notice in writing to
the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice),
and (2) if the insured is subject to the FMCSA’s registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice
to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, DC).

Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs.

(continued on next page)

FORM MCS-90 Page 1 of 3

FORM MCS-
MCS-90 Revised 01/05/2017 OMB No.: 2126-
2126-0008 Expiration: 01/31/2020

DEFINITIONS AS USED IN THIS ENDORSEMENT

Accident includes continuous or repeated exposure to conditions or Environmental Restoration means restitution for the loss,
which results in bodily injury, property damage, or environmental damage, or destruction of natural resources arising out of the
damage which the insured neither expected nor intended. accidental discharge, dispersal, release or escape into or
Motor Vehicle means a land vehicle, machine, truck, tractor, trailer, upon the land, atmosphere, watercourse, or body of water, of
or semitrailer propelled or drawn by mechanical power and used on a any commodity transported by a motor carrier. This shall
highway for transporting property, or any combination thereof. include the cost of removal and the cost of necessary
measures taken to minimize or mitigate damage to human
Bodily Injury means injury to the body, sickness, or disease to
health, the natural environment, fish, shellfish, and wildlife.
any person, including death resulting from any of these.
Public Liability means liability for bodily injury, property
Property Damage means damage to or loss of use of
damage, and environmental restoration.
tangible property.

The insurance policy to which this endorsement is attached or violation thereof, shall relieve the company from liability or from
provides automobile liability insurance and is amended to the payment of any final judgment, within the limits of liability
assure compliance by the insured, within the limits stated herein, herein described, irrespective of the financial condition, insolvency
as a motor carrier of property, with Sections 29 and 30 of the or bankruptcy of the insured. However, all terms, conditions, and
Motor Carrier Act of 1980 and the rules and regulations of the limitations in the policy to which the endorsement is attached shall
Federal Motor Carrier Safety Administration (FMCSA). remain in full force and effect as binding between the insured and
In consideration of the premium stated in the policy to which this the company. The insured agrees to reimburse the company for
endorsement is attached, the insurer (the company) agrees to pay, any payment made by the company on account of any accident,
within the limits of liability described herein, any final judgment claim, or suit involving a breach of the terms of the policy, and for
recovered against the insured for public liability resulting from any payment that the company would not have been obligated to
negligence in the operation, maintenance or use of motor vehicles make under the provisions of the policy except for the agreement
subject to the financial responsibility requirements of Sections contained in this endorsement.
29 and 30 of the Motor Carrier Act of 1980 regardless of whether or It is further understood and agreed that, upon failure of the
not each motor vehicle is specifically described in the policy and company to pay any final judgment recovered against the
whether or not such negligence occurs on any route or in any insured as provided herein, the judgment creditor may
territory authorized to be served by the insured or elsewhere. Such maintain an action in any court of competent jurisdiction
insurance as is afforded, for public liability, does not apply to injury to against the company to compel such payment.
or death of the insured’s employees while engaged in the course of The limits of the company’s liability for the amounts prescribed
their employment, or property transported by the insured, designated in this endorsement apply separately to each accident and any
as cargo. It is understood and agreed that no condition, provision, payment under the policy because of anyone accident shall not
stipulation, or limitation contained in the policy, this endorsement, or operate to reduce the liability of the company for the payment of
any other endorsement thereon, final judgments resulting from any other accident.

(continued on next page)

FORM MCS-90 Page 2 of 3

FORM MCS-
MCS-90 Revised 01/05/2017 OMB No.: 2126-
2126-0008 Expiration: 01/31/2020

SCHEDULE OF LIMITS — PUBLIC LIABILITY

Type of carriage Commodity transported January 1, 1985

(1) For-hire (in interstate or foreign commerce, with a Property (nonhazardous) $750,000
gross vehicle weight rating of 10,000 or more pounds).
(2) For-hire and Private (in interstate, foreign, or Hazardous substances, as defined in 49 CFR 171.8, $5,000,000
intrastate commerce, with a gross vehicle weight transported in cargo tanks, portable tanks, or hopper-
rating of 10,000 or more pounds). type vehicles with capacities in excess of 3,500 water
gallons; or in bulk Division 1.1, 1.2, and 1.3 materials,
Division 2.3, Hazard Zone A, or Division 6.1, Packing
Group I, Hazard Zone A material; in bulk Division 2.1
or 2.2; or highway route controlled quantities of a
Class 7 material, as defined in 49 CFR 173.403.
(3) For-hire and Private (in interstate or foreign Oil listed in 49 CFR 172.101; hazardous waste, $1,000,000
commerce, in any quantity; or in intrastate commerce, hazardous materials, and hazardous substances
in bulk only; with a gross vehicle weight rating of defined in 49 CFR 171.8 and listed in 49 CFR 172.101,
10,000 or more pounds). but not mentioned in (2) above or (4) below.
(4) For-hire and Private (In interstate or foreign Any quantity of Division 1.1, 1.2, or 1.3 material; any $5,000,000
commerce, with a gross vehicle weight rating of less quantity of a Division 2.3, Hazard Zone A, or Division
than 10,000 pounds). 6.1, Packing Group I, Hazard Zone A material; or
highway route controlled quantities of a Class 7
material as defined in 49 CFR 173.403.
*The schedule of limits shown does not provide coverage. The limits shown in the schedule are for information purposes only.

FORM MCS-90 Page 3 of 3

 ADDITIONAL COVERAGE ENDORSEMENT

ENDOSO DE COBERTURA ADICIONAL

NO COVERAGE PROVIDED FOR ACCIDENTS OCCURRING IN MEXICO OR CENTRAL AMERICA

This endorsement is not valid unless attached to Declaration Page of Policy No. / Endoso inválido a menos
que acompañe a la Carátula de la Póliza Número: 1031320-1
Policy Period From: 06 NOV 2017 To: 06 NOV 2018
Insured Name / Nombre del Asegurado Insureds Address / Dirección Asegurado
1850 LINCOLN AVE SPC 71
IVONNE PADILLA & FRANKLIN PADILLA DBA PADILLA
City, /TRANSPORT
Ciudad State/ Estado ZIP Code Tel. Number
CALEXICO CALIFORNIA 92231 7608794477
INCLUDED COVERAGE DESCRIPTION / DESCRIPCIÓN DE COBERTURAS INCLUIDAS
(GMO) GASTOS MEDICOS OCUPANTES
INCLUDED
REPORTAR AL: (888)-334-0114
Limit / Suma Asegurada: GASTOS MEDICOS OCUPANTES: $2,000.00 PER PERSON /$6,000.00 PER ACCIDENT 0.00 US Dollars
WE WILL PAY REASONABLE AND CUSTOMARY EXPENSES INCURRED FOR NECESSARY MEDICAL AND FUNERAL SERVICES BECAUSE OF BODILY INJURY: CAUSED BY
AUTO ACCIDENT IN THE U.S.A.; AND SUSTAINED BY AN INSURED PERSON. WE WILL PAY ONLY THOSE EXPENSES INCURRED WITHIN ONE YEAR FROM THE DATE OF
THE ACCIDENT. PLEASE READ CAREFULLY THE TERMS AND CONDITIONS OF THIS COVERAGE EXPLAINED ON FORM AVAILABLE
HTTP://WWW.CAICSEGUROS.COM/SPA/FORM201.PDF OR ASK YOUR AGENT FOR A COPY TO UNDERSTAND ALL COVERED AND EXCLUDED ITEMS.
EN CASO DE LESIONES O MUERTE DE LOS OCUPANTES DEL VEHÍCULO ASEGURADO COMO CONSECUENCIA DE UN ACCIDENTE AUTOMOVILÍSTICO PAGAREMOS
HASTA LA SUMA ASEGURADA CONTRATADA POR PERSONA Y POR EVENTO. POR FAVOR LEA CUIDADOSAMENTE LOS TÉRMINOS Y CONDICIONES DE ESTA
COBERTURA EXPLICADOS EN LA FORMA 201 TAMBIÉN DISPONIBLE EN HTTP://WWW.CAICSEGUROS.COM/SPA/FORM201.PDF O SOLICITE UNA COPIA A SU AGENTE DE
SEGUROS PARA QUE IDENTIFIQUE TODAS LAS COBERTURAS Y EXCLUSIONES.

(CAR) CARGA
INCLUDED
REPORTAR AL: (866) 969-3899
Limit / Suma Asegurada: $100,000.00 PER ACCIDENT 1313.00US Dollars
WITH A $1,000.00 USD DEDUCTIBLE (EXCEPT FOR TARGET INTERESTS). WE WILL ALL SUMS "YOU" MUST PAY BECAUSE
OF "LOSS" TO "COVERED PROPERTY" WHILE IN "YOUR" CUSTODY OR CONTROL IN THE ORDINARY COURSE OF TRANSIT
FOR WHICH "YOU" ARE LEGALLY LIABLE AS A "MOTOR CARRIER" UNDER A UNIFORM BILL OF LADING OR SHIPPING
RECEIPT, OR AS OWNER OF GOODS, EXCEPT AS EXCLUDED PER POLICY WORDING. READ CAREFULLY THE TERMS AND
CONDITIONS OF THIS COVERAGE EXPLAINED ON FORM – 610 AVAILABLE AT
WWW.CAICSEGUROS.COM/SPA/FORM610.PDF OR ASK YOUR AGENT FOR A COPY TO UNDERSTAND ALL COVERED AND
EXCLUDED ITEMS.

(PDV) DAÑOS MATERIALES VEHICULO

INCLUDED
REPORTAR AL: (866) 969-3899
Limit / Suma Asegurada: PER DECLARED VALUE AND SUBJECT TO ACV. READ ENDORSEMENT MC11100200 SECTION III ITEM C- ON FORM 1211.00US Dollars
640

WITH A $1,000.00 OR 5% DEDUCTIBLE. WE WILL PAY FOR “LOSS” TO A COVERED “AUTO” OR ITS EQUIPMENT UNDER: 1)
COMPREHENSIVE COVERAGE (FROM ANY CAUSE EXCEPT AS PROVIDED IN POLICY FORM 640 PART MC 11100200). 2) SPECIFIED
CAUSES OF LOSS COVERAGE (CAUSED BY FIRE, LIGHTNING OR EXPLOSION; THEFT; WINDSTORM, HAIL OR EARTHQUAKE; FLOOD;
MISCHIEF OR VANDALISM; OR THE SINKING, BURNING, COLLISION OR DERAILMENT OF ANY CONVEYANCE TRANSPORTING THE
COVERED “AUTO”). 3) COLLISION COVERAGE (CAUSED BY: THE COVERED “AUTO’S” COLLISION WITH ANOTHER OBJECT; OR THE
COVERED “AUTO’S” OVERTURN). READ CAREFULLY THE TERMS AND CONDITIONS OF THIS COVERAGE EXPLAINED ON FORM – 640
AVAILABLE AT WWW.CAICSEGUROS.COM/SPA/FORM645.PDF OR ASK YOUR AGENT FOR A COPY TO UNDERSTAND ALL COVERED
AND EXCLUDED ITEMS.

(TI) REMOLQUE INDISTINTO

INCLUDED
REPORTAR AL: (866)-500-9813
Limit / Suma Asegurada: $30,000.00 PER ACCIDENT 473.00 US Dollars

WITH A $1,000.00 DEDUCTIBLE. WE WILL PAY ALL SUMS YOU LEGALLY MUST PAY AS DAMAGES BECAUSE OF “LOSS” TO A “TRAILER” YOU DON’T
OWN OR ITS EQUIPMENT UNDER: COMPREHENSIVE COVERAGE (FROM ANY CAUSE EXCEPT: THE “TRAILER’S” COLLISION WITH ANOTHER OBJECT
;OR THE “TRAILER’S” OVERTURN).SPECIFIED CAUSES OF LOSS COVERAGE (CAUSED BY: FIRE, LIGHTNING OR EXPLOSION; THEFT; WINDSTORM,
HAIL OR EARTHQUAKE; FLOOD; MISCHIEF OR VANDALISM; OR THE SINKING, BURNING, COLLISION OR DERAILMENT OF ANY CONVEYANCE
TRANSPORTING THE “TRAILER”). COLLISION COVERAGE (CAUSED BY: THE “TRAILER’S” COLLISION WITH ANOTHER OBJECT; OR THE “TRAILER’S”
OVERTURN). READ CAREFULLY THE TERMS AND CONDITIONS OF THIS COVERAGE EXPLAINED ON FORM – 630 AVAILABLE AT
WWW.CAICSEGUROS.COM/SPA/FORM630.PDF OR ASK YOUR AGENT FOR A COPY TO UNDERSTAND ALL COVERED AND EXCLUDED ITEMS.