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HomeMy WebLinkAbout465554 GREYHOUND LINES INC - INSURANCE CERTIFICATE (4)YSluptxpt e CERTIFICATE OF LIABILITY INSURANCE D12/19/2ATE 3 1 F ACORO 1z/19/zo13 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: Tanya D. Stephenson Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX INC. No, E.O: 212-994-7100 lyyg IN: 212-994-7047 250 Perk Avenue 3rd Floor New York, MY 10177 MSUIIFD Greyhound Lines, Ian. 46 ss5� 350 N. Et. Paul St. Dallas, TX 75201 E-MAIL ADDRESS: Tanya SteDhenson0aj9.Cos INSURER(S) AFFORDING COVERAGE Nm INSURER A: INSURANCE CO OF THE STATE OF PA 1%" INSURER a: NATIONAL UNION FIRE INS CO OF PIT" - 19"s INSURER C: NEW HATQPSHIRN INS -CO -_ -- 23841 INSURER D: INSURER E : COVFRAr.FR CFRTIFICATF NIIMRFR- 37457637 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 AOOLSUSR EFF POLICY EXP TR TYPEOFNISURANCIE POLICY NUMBER wm LMM GENERALLAINUTY OL949389 12/31/1 12/31/14 EACH OCCURRENCE 4 5,000,000 DAMAGE TO RENTED - 45,000,000 _COMMERCIAL GENERAL LIABILITY _ CWMS#uOE �OCtlR PREMISES (Ea _. LE_DEXPOn.paam) $50,000 1BAWMy0Y,6LA§Lffy PERSONAL I ADV INJURY $5.000,000 _ GENERAL AGGREGATE 1 10,000, 000 GENL AGGREGATE LOT APPLIES PER: PRODUCTS - COMPXIP AGG s5, 000, 000 POLICY n X LOC 1 49248(AOS) COMBINED SINGLE LIMIT 5, 000, 000 A X CUS82242(VA) 12/31/1 12/31/14 (Ea occdent) - BODILY INJURY (Per parson) - 6 IS µyG - - C49248(TX) A9 12/31/1 12/31/il -- - ILLOWNED SCHEDULED BODILY SIJURY (PwaarBms) f B AUTCs -JUJITICS CI1882243 (NA) 12/31/1 12/31/14 -- - D PROPERTY DAMAGE 4 HIREDAUT0/ AUTOS s«ws ) 4 IIIIBREW LW OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS IJA! CLAMEMADE 6 DIED RETE I s C eroeXER%COIM UT10N 1705104(AOS) 12/31/1 12/31/14 X T WCLIMITS.. AIR E3IPLDYERF LWNRY YIN -- - C ANY PNOPRIETOR/PARTNERh%EDUUVE 1705301(1F11, 1705095(FL) 12/31/1 12/31/14 E EACHACCIOENT s 5,000,000 C OFFICERNEMBER EXCLUDED? layseoio coy In am NIA 1705096(OR), 1705097(TX) 12/31/1 12/31/14 EL DISEASE EA EMPLOYEE $ 5. 000, 000 12/31/14 IS 5,000,000 C DESCRIPTNJN of OPERATIONS bolo. MC1705104(AOS),1705099( ) 12/31/1 ELDISEASE-POLICYLIMIT C Workers Compensation 44216119(NA)44216118(MN) 12/31/1 12/31/14 R.L. Bach Accident 9,000,000 C Worker: Compeneation 1705100 (IL,NC,NH,OT,VT) 12/31/3 12/31/14 N.L. Disease -EA Emp5,000,000 B.L. Dieeaee-Policy5,000,000 OEKRIPTpNWW MTNNHSILOCATNNISIVEHICLES IAaacM1 ACORD 101, AE0Hbnal RemMFSchMUM.NewIF NmFaYNgWIM) City of Fort Collins is included as Additional Insured an required by mitten contract subject to policy terse, conditions and exclusions rith Greyhound Lines, Inc. for leased location at; 250 Masson Street, Ft. Collins, CO. r9PTIFICATP NOI nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Port Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P 0 BOX 580, 117 North Na:On Street AUTHORIZED REPRESENTATIVE Port Collins, CO 80522 C 1 USA RJ 1985-2010 ACORD CORPORATION. All rights resemea. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD vinayny 37457637 �YxE dxilNxlE a AGENCY CUSTOMER ID: _ LOC #: A ® ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, Inc. Greyhound Lines, Inc. POLICY NUMBER 350 N. St. Paul St. CARRIER NAN.,DODE Dallas, T% 75201 EFFECTIVE DATE: Page of m ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Workers ComDensation:- Policy #: 62790765 (AZ, GA) 4 62790767 (NJ, PA) - Policy Term: 12/31/13 to 12/31/14- Carrier Name: NEW HANPSHIRH INS CO (NAIC 4:23861)- Limite: H.L. Each Accident / H.L. Disease -Ea Employee / B.L. DieeaSe-Policy Limit - $5,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All HOME reserved The ACORD name and logo are registered marks of ACORD