HomeMy WebLinkAboutFIRST STUDENT INC - INSURANCE CERTIFICATEACORD „. CERTIFICATE OF LIABILITY INSURANCE D 12/20 /DDNYYV)
/20/08
PRODUCER 1-212-994-7100 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J. Gallagher & Co. of New York ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
444 Madison Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
20th Floor
New York, NY 10022
INSURERS AFFORDING COVERAGE _ NAIC#
INSURED INSURERA: INSURANCE CO OF THE STATE OF PA 19429
FIRST STUDENT INC
INSURERS: NATIONAL UNION FIRE INS CO OF PITTS 19445
Vine St
Ste 1400
INSURERC:NEW HAMPSHIRE INS CO 23841
Ste
CINCINNATI, OR 45202 INSURERD:New Hampshire Ins Co 23841
COVFRAnFS
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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTA
ADUL
POLICYNUMBER
POLICY EFFECTIVE
12/31/08
POLICY EXPIflAT10N
LIMITS
A
LIABILITY
GL1737923 (10MM AGG)
12/31/09
EACH OCCURRENCE
$5,000,000
_GENERAL
X COMMERCIAL GENERAL LIABILITY
PREMISES Ea occumace
$ 50,000
CLAIMS MADE OCCUR
MED EXP(Any one person)
$50,000
PERSONAL &ADV INJURY
$ 5,000,000
GENERAL AGGREGATE
$ 10, 000, 000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OPAGG
$5,000,000
17 POLICY PRO' X LOC
__--
B
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
CA5273862 (MA)
CA5273859 (AOS)
12/31/08
12/31/08
12/31/09
12/31/09
COMBINEDSINGLE LIMIT
(Ea accident)
$5,000,000
BODILY INJURY
(Per person)
$
B
ALLOWNEDAUTOS
SCHEDULED AUTOS
CA5273864 (VA)
12/31/08
12/31/09
X
BODILY accident)
(Per accident)
8
HIREDAUTOS
NON -OWNED AUTOS
X
PROPERTY DAMAGE
(Peraccidenl)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EAACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
C
D
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANV PROPRIETOR/PARTNER/EXECUTIVE
117 85 83 (ADS)
117 85 30 (MA)1178529 (C
12/31/08
) 12/31/08
12/31/09
12 /31/09
X WRSLATU OTH
E.L.ELEACH ACCIDENT
$5,000,000
--
E.L. DISEASE - EA EMPLOYEE
$5, 000, 000
D
OFFICER/MEMBER EXCLUDED?
117 85 31 (IL,NY)123249(
I) 12/31/08
12/31/09
D
IlyE Cdescribe IAL PROVISIONS below
SPE
1178527(FL) & 1232492(TX
12 / 31/08
12/31/09
E.L. DISEASE- POLICY LIMIT
$5,000,000
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
NFRMPO, the cities of Greeley, Loveland, and Johnstown and the Counties of Latimer and Weld are shown
as additional insureds solely with respect to the General and Auto liability coverages as evidenced herein as
required by written contract with respect to work performed by the named insured.
Transit Service
Attn: Jame B. O'Neill
215 North Mason Street - 2nd. Flr
Collins, CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
USA
ACORD 9, t9001/OH1 camtroi
10618690
(.a _PQ
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25
ACORD,M CERTIFICATE OF LIABILITY INSURANCE
DaTE(MLvoonvvv)
12/20/08
PRODUCER 1-212-994-7100
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Arthur J. Gallagher & Co. of New York
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
444 Madison Avenue
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
20th Floor
New York, NY 10022
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
FIRST STUDENT INC
INSURERA: INSURANCE CO OF THE STATE OF PA
19429
INSURER B: NATIONAL UNION FIRE INS CO OF PITTS
19445
600 Vine St
Ste 1400
INSURERC:NEW HAMPSHIRE INS CO
23841
INSURERD:New Hampshire Ina Cc
23841
CINCINNATI, ON 45202
INSURER E
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TIN —SR
ADD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
POLICYEFFECTIVE
POLICY EXPIRATIONTR
LIMITS
A
GENERAL LIABILITY
CL1737923 (10MM AGO)
12/31/08
12/31/09
EACH OCCURRENCE
$5,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE 111 OCCUR
PREMISES Ea occurence
$ 50,000
MED EXP(Any one person)
$50,000
PERSONAL&ADV INJURY
$ 5,000,000
GENERAL AGGREGATE
$ 10,000,000
G EN'L AGGREGATE U MIT APPLI ES PER:
PRODUCTS-COMP/OPAGG
$5,000,000
POLICY PRO X LOC
H
H
AUTOMOBILE
LIABILITY
ANYAUTO
CA5273862 (NA)
CAS273859 (ADS)
12/31/08
12/31/08
12/31/09
12 /31/09
COMBINED SINGLE LIMIT
(Eaaccident)
$5,000,000
X
BODILY INJURY
(Per person)
$
H
ALLOWNEDAUTOS
SCHEDULED AUTOS
CA5273864 (VA)
12/31/08
12/31/09
X
BODI LY INJURY
(Peraccitlent)
$
HIREDAUTOS
NON OWNED AUTOS
X
PROPERTY DAMAGE
(Peraccitlent)
$
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT
$
OTHERTHAN EAACC
$
ANYAUTO
$
AUTOONLV: AGO
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
S
OCCUR CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION S
C
D
WORKERS COMPENSATION AND
EMPLOYERS'LIABIUTY
ANY PROPRIETOR/ PARTNER/EXECUTIVE
117 85 83 (ADS)
117 85 30 (MA)1178529 (CA)
12/31/08
12/31/08
12/31/09
12/31/09
X TWO STATU- OT H-
E.L. EACH ACCIDENT
$5,000,000
--
E.L. DISEASE - EA EMPLOYEE
$5,000,000
D
OFFICER/MEMBER EXCLUDED?
117 85 31 (IL, NY)123249(
2) 12/31/08
12/31/09
D
If S E describe under
SPECIAL PROVISIONS below
TX 1178527(FL) & 1232492(
12/31/08
12/31/09
E.L. DISEASE - POLICY LIMIT
$5,000,000
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Location # 5955 - NFRMPO, the cities of Greeley, Loveland, and Johnstown and the Counties of Lorimer and
Weld are shown as additional insureds solely with respect to the General and Auto liability as evidence herein
as required by written contract with respect to work performed by the named insured.
NFRMPO Transit Service
Attn: Jame B. O'Neill
215 North Mason Street - 2nd. Flr
Fort Collins, CO 80524
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08)
l Ublbbyl
USA
GC'wC�Q
f PT:T.]
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)