HomeMy WebLinkAbout465554 GREYHOUND LINES INC - INSURANCE CERTIFICATE (3)Pglaxewrrl
ACo ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD1210/2 I
12
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).
CONTPRODUCER 1-212-994-7100 NAMEACT Tanye D. Stephenson
Arthur U. Gallagher Risk Management Services, Inc. — - 99--
Iu�Nu„ cm. 212-994-7085 a ��,. 212-994-7047
250 Park Avenue
3rd Floor
New York, NY 10177
INSURED `� " l 1
Greyhound Lines, Inc.
350 N. St. Paul St.
Dallas, T% 75201
EMAIL _a
ADDRESS:Ta_n_Y_Bteheneon@a_ _ _ D_. jg.c=
INSURERISIAFFORDING GOVERACE
INSURER A_INSURUIN CE CO OF THE STATE OF PA
_INSURER 8: NATIONAL UNION FIRE INS CO OF PITTS
T NAIC4
19429
19445
INSURER C_ILLINOIS NATL INS CO
23817
23841
_INSURER D: NEW HAMPSHIRE INS CO
INSURER E_
INSURER F
COVERAGES CFRTIFICATF NIIMRFR- 30580627 Rcanclnu w worn.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO'r. HAVE BEEN ISSUED TO 'rHE INSURED NAMED ABOVE FOR THE POLICV'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'CLAIMS .
I
MMIPAID
LTR I TYPE OF INSURANCE iAODL SUBR POLICY NUMBER MMIOOIYYYy DONYTY I LIMILB
A
I GENERAL LIABILITY
_
GL949389
12/31/12
12/31/13
_EACHOCCURRENCETO
5,000, 000
_q
55, 000, 000
%
COMMERCIAL GENERAL LIABILITY
FFF
DAMAGE TO RENTEDRRENCE
(Ea occunenca)_
1 CLAIMS -MADE lxl OCCUR
_PREMISES
MED EXP (Any one person)_
$ 50, 000
PERBONALd ADV INJURY
$ 5,000,000
GENERAL AGGREGATE
S 10, 000, O
GENL AGGREGATE
LIMIT APPLIES PER:
_
PRODUCTS COMPIOP AGG
15,000,000
11-1 POLICY
II PRo- I X I LUC
IS
B
'AUTOMOBILE
LIABILITY
ICA949249(VA)a
12/31 1
12/31/13
COMBINED SINGLE LIMIT
$ 5,000,000
C
X
ANY AUTO
CA949298 (T%)•
12/31/12
I
12/31/13I
{Ea acciden9_
B
ALL OWNED SCHEDUlEO
G949267 (A05)
12/31/12
12/31/13
BODILY INJURY (Perperson)
5
—
AUTOS _
W
BODILY INJURY IPera x1enll
L
S
�1
HIRED AUTOS X IAUTOS NON -OWNED
PROPERTY-DAM
(Per acciden0__
5
$
Ij
UMBRELLA
OCCUR
I
EACH OCCURRENCE
SIEXC
S LU CLAIMS MADEi
L
AGGREGATE I
S
I RETE
s
D
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY
1705101(WI), 1705095(FL)
12/31/12
12/31/13
X WC WATD-I OTH
I�_ TORYUMITSLLER___
D
YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED? ❑
NIA
WC1705104(AOS), 1705099(CA)
12/31/12
12/31/13
E.L. EACH ACCIDENT_
$ 5,000,000
E.L. DISEASE - EA EMPLOYEES
5,000,000
D
(Mandatory In NH)
1705104(AOS), 1705100(IL,
NY It2/31/12
12/31/13
D
uMer
DESCRIPTION OF OPERATIONS DeIow
DESCRIPTION
1705096 (OR), 1705097 (TX) I
I
12/31/la
12 /31/13
— DISEASE -POLICY LIMIT 3 5, 000, 000
�I
D
Workers Compensation
44216119(MA)44216118(MN)
12/31/12
12/31/111
E.L. Each Accident 5,000,000
E.L. Disease -Ea Emp 5,000,000
E.L. Diseaae-Policy5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aft.1h ACORD 101, Additional Remark. Sc6adola, if more apace la ra..Irad)
City of Fort Collins is included as Additional Insured as required by written contract subject to policy terme,
conditions and exclusions with Greyhound Lines, Inc. for leased location at: 250 Masan Street, Ft. Collins, CO.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ty of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
0 Box 5BO, 117 North Mason Street AUTHORIZED REPRESENTATIVE
rt Collins, CO 80522 -x
I USA / L
1988-2010 ACORO CORPORATION All .i.ht.o..,ed
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
anuDny
30580627
Ma