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TruckSpace Package
TruckSpace Package
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
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 100,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
A OWNED
AUTOS ONLY
SCHEDULED
AUTOS
SMC1802882 11/15/2021 11/15/2022 BODILY INJURY (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
Y/N
ANY PROPRIETOR/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 $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
GARY KAMALYAN
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
U.S. Department of Transportation 1200 New Jersey Ave., S.E.
Federal Motor Carrier Safety Administration Washington, DC 20590
SERVICE DATE
December 13, 2021
CERTIFICATE
MC-1322951-C
U.S. DOT No. 3739178
TRUCK SPACE INC
SAN FRANCISCO, CA
This Certificate is evidence of the carrier's authority to engage in transportation as a common carrier of
property (except household goods) by motor vehicle in interstate or foreign commerce.
This authority will be effective as long as the carrier maintains compliance with the requirements
pertaining to insurance coverage for the protection of the public (49 CFR 387) and the designation of
agents upon whom process may be served (49 CFR 366). The carrier shall also render reasonably
continuous and adequate service to the public. Failure to maintain compliance will constitute sufficient
grounds for revocation of this authority.
NOTE: Willful and persistent noncompliance with applicable safety fitness regulations as evidenced by a
DOT safety fitness rating of "Unsatisfactory" or by other indicators, could result in a proceeding requiring
the holder of this certificate or permit to show cause why this authority should not be suspended or
revoked.
CMO
Form
(Rev. October 2018)
W-9 Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service ▶ Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
Truck Space Inc
2 Business name/disregarded entity name, if different from above
See Specific Instructions on page 3.
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
following seven boxes. certain entities, not individuals; see
instructions on page 3):
✔ C Corporation S Corporation Partnership Trust/estate
Individual/sole proprietor or
single-member LLC Exempt payee code (if any)
Print or type.
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions) ▶ (Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions. Requester’s name and address (optional)
1249 18TH AVE 102
6 City, state, and ZIP code
SAN FRANCISCO, California, 94122
7 List account number(s) here (optional)
Sign Signature of
Here U.S. person ▶ Date ▶ 12/01/2021
General Instructions • Form 1099-DIV (dividends, including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise • Form 1099-MISC (various types of income, prizes, awards, or gross
noted. proceeds)
Future developments. For the latest information about developments • Form 1099-B (stock or mutual fund sales and certain other
related to Form W-9 and its instructions, such as legislation enacted transactions by brokers)
after they were published, go to www.irs.gov/FormW9.
• Form 1099-S (proceeds from real estate transactions)
Purpose of Form • Form 1099-K (merchant card and third party network transactions)
An individual or entity (Form W-9 requester) who is required to file an • Form 1098 (home mortgage interest), 1098-E (student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T (tuition)
identification number (TIN) which may be your social security number • Form 1099-C (canceled debt)
(SSN), individual taxpayer identification number (ITIN), adoption
• Form 1099-A (acquisition or abandonment of secured property)
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other Use Form W-9 only if you are a U.S. person (including a resident
amount reportable on an information return. Examples of information alien), to provide your correct TIN.
returns include, but are not limited to, the following. If you do not return Form W-9 to the requester with a TIN, you might
• Form 1099-INT (interest earned or paid) be subject to backup withholding. See What is backup withholding,
later.