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HomeMy WebLinkAbout465554 GREYHOUND LINES INC - INSURANCE CERTIFICATEkc �� CERTIFICATE OF LIABILITY INSURANCE FFA2T12112010 ' 12/21/2010 -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER 1-212-994-7100 CONTACT NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE T 'FAX M. No. E AIC No): E-MAIL ADDRESS: 444 Madison Avenue 20th Floor PRODUCER New York, NY 10022 CUSTOMER ID INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: INSURANCE CO OF THE STATE OF PA 19429 Greyhound Lines, Inc. INSURER B: NATIONAL ONION FIRE INS CO OF PITTS 19445 INSURERC: ILLINOIS NATL INS CO 23817 350 N. St. Paul St. INSURER D: NEW HAMPSHIRE INS CO 23841 Dallas, TX 75201 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 18833964 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 LTR TYPE OF INSURANCE ADDL SUER POLICPOLICY NUMBER MM DDY EFF MM/ DEXP / LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR GL0949389 12/31/1 12/31/11 EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 5,000,000 MED EXP (Any one person) $ 50,000 PERSONAL & ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO-JECT F-1 LOC POLICY PRODUCTS-COMP/OP AGG $ 5,000,000 $ B B C AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA0949249(VA) CA0949247 (AOS) CA0949248(TX) 12/31/1 12/31/1 12/31/1 12/31/11 12/31/11 12/31/11 COMBINED SINGLE LIMIT (Ea accident) $ 5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB H. OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ D D D D WORKERS'COMPENSATION AND EMPLOYERS' LIABILITYI ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) DESCRIPTIONNunder If yes,desclibOFO OPERATIONS below N / A WC1705104,WC1705100 WC1705101 & 1705095 WC1705102,WC1705103,1705 WC1705096, WC1705097 12/31/1 12/31/1 912/31/1 12/31/1 12/31/11 12/31/11 12/31/11 12/31/11 X WCSTATU- OTH- FIR E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 E.L. DISEASE - POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Fort Collins is included as Additional Insured as required by written contract subject to policy terms, conditions and exclusions with Greyhound Lines, Inc. for leased location at: 250 Mason Street, Ft. Collins, CO. UAINUCLLA I IUIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 580, 117 North Mason Street AUTHORIZED REPRESENTATIVE Fort Collins, CO 80522 USA nasirny ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 18833964