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HomeMy WebLinkAbout465554 GREYHOUND LINES INC - INSURANCE CERTIFICATE (2)PSNWLGLp3 � ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) „ A 1z/avzou 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. p .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: G Arthur a. Gallagher Risk Management Services, Inc. PHONE FAX ^I .LAIC,No,EXIP (NC NO): 9 E-MAIL ADDRESS: 250 Park Avenue 2- 3rd Floor m New York, NY 10177 INSURERL)AFFORDING COVERAGE NAIC0 INSURER A: INSURANCE CO OF THE STATE OF PA 19429 INSURED INSURERS: ILLINOIS NAIL INS CO 23817 Greyhound Lines, Inc. INSURER C: NATIONAL UNION PIAE INS CO OF PITTS 19445 350 N. St. Paul St. INSURER D. NEW HAMPSHIRE INS CO 23841 INSURER E: Dallas, TX 752D1 INSURER F: COVERAGES CERTIFICATE NUMBER- 24582158 REVISION NUMBER: THIS-15 TOCERTIFYTHAT THE'POLICIES OF INSURANCE LISPED 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 OF INSURANCE ABUTYPE INSR Won POLICY NUMBER MNIDDIYYYY MNL DBIYYYY LIMITS A GENERALLIABILITY GL949389 12/31/11 12/31/12 EACH OCCURRENCE $5,000,000 X DAMAGE TO RENTED 5,000,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS -MADE X OCCUR MED EXP(Any one person) $50,000 PERSONAL B ADV INJU RY $ 5,000,000 GENERAL AGGREGA I E $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP ADS $5,000,000 POLICY PRO. X LOG FCT S B AUTOMOBILE LIABILITY CA949248(TX) 12/31/11 2/3 / 2 COMBINED SINGLE LIMIT 5,000,000 C X CA999249 (VA) 12/31/11 12/31/12 BEUINJURY(Per person) $ BODILY AAUTO _ C CA999247 (ADS) 12/31/11 12/31/12 - ALL OWNED SCHEDULED BODILY INJURY (Per accKMn1) $ AUT AUTO$ O$ X X NON OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS (Per aamN) S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIPS CLAIMS -MADE AGGREGATE S DIED RETENTIONS 3 D WORKERS COMPENSATION WC1705104(ADS), 1705099(CA) 12/31/11 12/31/12 X WOSTATU- OTH- TORY LIM116 ER AND EMPLOYERS' LIABILITY IN YI� D ANY PROPRIETORIPARTNERIEXECUTIVE 1705104(ADS), 1705100(I L, N" 2/31/11 12/31/12 EL EACH ACCNEN1 5 5,000,000 EMB OFFICERMER EXCLUOEDi u D (Mandatory In NH) NIA 1705096(OR), 1705097(TX) 12/31/11 12/31/12 E.L. DISEASEEAEMPLOYEE S 5,000,000 D If yes DESCRIPTION antler DESCRIPTION OF OPERATIONS below 1705101(WI), 1705095(FL) 12/31/11 12/31/12 5,000,000 EL. DISEASE -POLICY LIMIT $ D Workers Cou eneation 44216119(MA) 44216118(Tm) 12/31/11 12/31/12 E.L. Each Accident 5.000,000 E.L. Disease -Ea Emp 5,000,000 B.L. Disease-Policy5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addiflored Remains Schedule, If more apace Is regplredl City of Fort Collins in included as Additional Insured as required by Written contract subject to policy terns, conditions and exclusions With Greyhound Linea, Inc. for leased location at: 250 Mason Street, Ft. Collins, CO. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 0 Box 580, 117 North Mason Street AUTHORIZED REPRESENTATIVE rt Collins, CO 80522 ^ _ USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD srininy 24582158 ..-