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HomeMy WebLinkAboutFIRST TRANSIT INC - INSURANCE CERTIFICATE (5)ACORO® DTE (MMDD/YY) ,2/19lDYYYV CERTIFICATE OF LIABILITY INSURANCE A 018 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Tanya D. Stephenson Arthur J. Gallagher Risk Management Services, Inc. PHoriE — P- -- --" FAz _ -- 250 Park Avenue - 212-994-7085 AIc No): 212-994-7047 3rd Floor ADDRESS: Tana Ste henson a' .com New York NY 10177 INSURERS) AFFORDING COVERAGE NAIC# INSURER A: National Union Fire Insurance Company of Pittsburg19445 INSURED INSURER B: New Hampshire Insurance Company 23841 FIRST TRANSIT, INC. _ ...,_.- 600 Vine Street, Suite 1400 INSURERC: American Home Assurance Company 19380 Cincinnati, OH 45202 INSURER0: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:1588604464 REVISION NLIMRER- 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' _..__..- ADOL U601'`; _ .....POLICY EFF POLICY EXP `-... _ ._-.___ ..-....... LTR TYPE OF INSURANCE POLICY NUMBER MM'DD/YYYY MMIDD/YYYY 1 LIMITS A X COMMERCIAL GENERAL LIABILITY GL3629890 12/31/2018 12/31/2019 i EACH OCCURRENCE $5,000,000 X 15AMA6E TO'REN1 CLAIMS -MADE OCCUR I I $ 5,000,000_ gXL�bus. and MED EXP Any one person) $olestation Ind PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $10,000,000 GENERAL AGGREGATE —. POLICY PRO- I X I X _ �—i JECT _ LOC PRODUCTS • COMP/OP AGG - $ 5,000,000 OTHER: A AUTOMOBILE LIABILITY CA1921809(AOS) 12/31/2018 12/31/2019 1 Me COMBINED SINGLE LIMIT accident) $5,000,DD0 A X i ANY AUTO CA1921810 (MA) 12/31/2018 CA1921808 (VA) 12/31/2018 12/31l2019 j 12/31/2019 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par aooident) X HIRED X NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (P.er accident)-- _ _ i $ UMBRELLALIAB _ OCCUR EACHOCCURRENCE $ EXCESS LIAR _ CLAIMS -MADE i I AGGREGATE _—_ _ _- $v__ _ DED RETENTION $ $ e WORKERS COMPENSATION WC 014649551 (AOS) 12/31/2018 12/31/2019 X 'PER OTH STATUTE I L B AND EMPLOYERS' LIABILITY Y / N WC014649558(MN) 12/31/2018 12131 /2019 - B ANYPROPRIETORIPARTNb'EXECUTIVE OFFICER,MEMBEREXCLUDED? ❑B NA WC014649547 (FL) 12/31/2018 12/31/2019 E.L EACH ACCIDENT $ 5,000 000 $ 5,0D0,000 B (Mandatory In NH} WC014649549(MA,WI) WC014649548(CA) 12l31/2018 12/31l2018 12l31/2019 E L^ DISEASE . EA EMPLOYEE ! 12/31/2019 _. I If yes. describe under DESCRIPTION OF OPERATIONS helaw WC 014649559 (ME) 12/31l2018 ' 12/31/2019 E.L. DISEASE - POLICY LIMIT $ 5,000,000 I i i I DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Workers Compensation: Policy #: WC 014649550 (AK. AZ, IL, NC, NH, NJ, PA, UT, VA VT) Policy Term: 12/31 /18 to 12/31 /19 Carrier Name: NEW HAMPSHIRE INS CO (NAIC #:23841) Limits: E.L. Each Accident / E.L. Disease- Ea Employee / E.L. Disease -Policy Limit - $5,000,000 Location # 5955 - NFRMPO, the cities of Greeley, Loveland, and Johnstown and the Counties of Larimer and Weld are shown as additional insureds solely with respect to the General and Auto liability as evidence herein as required by written contract. The General liability policy form evidenced herein includes a Separation NFRMPO Transit Service 215 North Mason Street - 2nd. Flr Fort Collins CO 80524 USA CANCEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4 of 4 20225