Tom Jacobs Trucking USDOT 1090310

Insurance Form	Insurance Type	Insurance Carrier	Policy/Surety	Coverage Amount From	Coverage Amount To	Effective Date From	Effective Date To
91X	BIPD/Primary	Great West Casualty Co.	GWP60456A	$0	$1,000,000	02/07/2009	03/08/2012 Cancelled
91X	BIPD/Primary	Harco National Insurance Co.	TP3038383	$0	$1,000,000	02/07/2005	02/07/2009 Replaced
91X	BIPD/Primary	Northland Insurance Company	TN383947	$0	$1,000,000	02/07/2003	02/07/2005 Replaced

* If a carrier is in compliance, the amount of coverage will always be shown as the required Federal minimum ($5,000 per vehicle, $10,000 per occurrence for cargo insurance and $75,000 for bond/trust fund). The carrier may actually have higher levels of coverage.';

Harco National Insurance Co. 2850 WEST GOLF RD. ROLLING MEADOWS, IL Fax:(847)734 - 4089

Great West Casualty Co. 1100 WEST 29TH ST., P.O. BOX 277 SOUTH SIOUX CITY, NE Fax:(402)494 - 7400

Northland Insurance Company 385 WASHINGTON STREET MAIL CODE 103 ST. PAUL, MN Fax:(651)310 - 4949