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Home My WebLink About465554 GREYHOUND LINES INC - INSURANCE CERTIFICATE (6)oRo� CERTIFICATE OF LIABILITY INSURANCE DATE (MMl 12/19/2018 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 Arthur J. Gallagher Risk Management Services, Inc. 250 Park Avenue 3rd Floor New York NY 10177 INSURED Greyhound Lines, Inc. 350 N. St. Paul St. Dallas, TX 75201 NAME"Tanya D_Stephenson PHONE 212-994-7085 FAX No,- ,No): 212-994-7047 c EMAIL ADDRESS: Tanya _Stephen son a' .com INSURERS) AFFORDING COVERAGE NAIC # _ INSURER A: New Hampshire Insurance Com pany23841 INSURER B _. National Union Fire Insurance Cmp!1gy of Pittsburg 19445 INSURER C : American Home Assurance Company 19380 INSURER D : INSURER E COVERAGES CERTIFICATE NUMBER:1781254453 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. '--- _-__ A6b��OB- -- _PPOIICY EFF POLICY b(P ILTR' LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMDDiYYYY LIMITS a X COMMERCIAL GENERAL uaeluTv CLAIMS -MADE X OCCUR GL 3629887 12/31/2018 i 12/31/2019 EACH 1 EACH OCCURRENCE f$ (6a gcpurrencej $ 5,000,000 $ 5,000,000 X Contractual - MED EXP (Arty one person) $ X] Uab Incl. PERSONAL 8 ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,D00,000 POLICY �� JECOT LOC —I i PRODUCTS -COMP/OP AGG - - $ 5,000,000 .- OTHER: i $ S AUTOMOBILE LIABILITY CA 1921794 (AOS) 12/31/2018 12131l2019 COMBINED SINGLE LIMIT $ 5,000 000 B CA1921795(MA) 12/31 /2018 12/3,12019 B X ANY AUTO CA1921796 A ) 12/31l2018 12/31/2019 BODILY INJUdenJJ_RY NJURY (Per person) j $ 1- OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY P r ��rl�@ntl _ .- $ UMBRELLALIAB j OCCUR �. ( I EACH OCCURRENCE— $ EXCESS LIAR CLAIMS -MADE l AGGREGATE - -` $ `-- $ DED RETENTION $ A WORKERS COMPENSATION I WC 014649556 (ADS) 1213112018 i 12/31/2019 X P R OTH- T�) �R i A AND EMPLOYERS' LIABILITY y ! N A ANYPROPRIETOR/PARTNER/EXECUTIVE WC 014649555 (WI,MA) 12/31/2018 12/31/2019 `"' __aa 1 -� E.L.EACH ACCIDENT -- - -- A OFFICER/MEMBEREXCLUDEO? ❑ OFFICEto N/A WC 0 14649552 (FL) 12/31/2018 12/31/2019 -- - $5,000,000 c NH ) WC 014649557 MN WC 014649553 (CA) 12/31/2018 12/31/2019 E.L DISEASE . EA EMPLOYEE 12/31/2018 i 12/31/2019 .. _.-.._._. _ __ _ $ 5,000,000 l(Mandatory It yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY OMIT $ 5,000.000 i I I DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Workers Compensation. Policy #: WC 014649554(AZ,IL,KY,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 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. City of Fort Collins P O Box 580, 117 North Mason Street Fort Collins CO 80522 USA 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 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2 of 2 20224