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HomeMy WebLinkAboutFIRST STUDENT INC - INSURANCE CERTIFICATE (8)AcoR CERTIFICATE OF LIABILITY INSURANCE DATE2015IYYYY) 12/17l2015 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 endorsements . PRODUCER CONTACT NAME: Tana D. Stephenson Arthur J. Gallagher Risk Management Services, Inc. PHONE 212 994-7085 FAX 212-994-7047 250 Park Avenue WNg 3rd Floor E-MA'L , Tanya_Stephenson@ajg.com New York NY 10177 INSURER S)AFFORDING COVERAGE NAIC# INSURED FIRST STUDENT, INC. 600 Vine St Ste 1400 CINCINNATI OH 45202 INSURER A: Insurance Company of State of PA 19429 INSURER B : National Union Fire Insurance Coma 19445 INSURER c : New Hampshire Insurance Companv 23841 F: Crl\/FDAnriz CFDTIGIrATF IUI IMRGD• 13046528 D11:111C,in1U IUI IIIJInr0- 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 LTR TYPE OF INSURANCE 1 WVD POLICY NUMBER POLICY EFF DIYYYY POLICY EXP MMOD LIMITS A X COMMERCIAL GENERAL LIABILITY GL 173-79-23 (10MM AGG) 12/31/2015 12/31/2016 EACH OCCURRENCE $5,000,000 CLAIMS -MADE Fix OCCUR DAMAGE TO RENTED -- PREMISES Ea occurrence $5,000,000 MED EXP (Any one person) E PERSONAL & ADV INJURY $5,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 POLICY 7 PE� FX7 LOC PRODUCTS - COMP/OP AGG $5,000,000 E OTHER: B B A AUTOMOBILE LIABILITY ANY AUTO CA5273859 AOS ( ) CA5273862 (MA) CA4882241 (VA) 12/31/2015 12/31/2015 12/31/2015 12/31/2016 12/31I2016 12131/2016 Ea accident i 5,000,000 X BODILY INJURY (Per person) f BODILY INJURY (Per accident) $ AUTOSNED AUTOS NON -OWNED HIRED AUTOS N AUTOS X Per accident t $ UMBRELLA LIAR EACH OCCURRENCE f HOCCUR AGGREGATE f EXCESS LIAB CLAIMS -MADE DED I I RETENTION E $ C C C C C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC1178531(IL,NC,NH,UT,VT) WC001178529 (CA) WC001178583 (AOS) WC44216118(MN) WC001 178527 (FL) WCOO1178530 (MA) 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2016 12/31/2016 12/31/2016 1Z/31/2016 12/31/2016 12/31/2016 X STATUTE ERH E.L. EACH ACCIDENT $5,000,000 E.L. DISEASE - EA EMPLOYE $5,000,000 E.L. DISEASE - POLICY LIMIT $5,000,000 I i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Workers Compensation: Policy #: WC001178530 (WI), WC 001178531 (AK,AZ,GA), WC001178583 (TX), & WC 001178531 (NJ,PA) Policy Term: 12/31 /15 to 12/31 /16 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 See Attached... CERTIFICATE HOLDER CANCELLATION NFRMPO Transit Service 215 North Mason Street - 2nd. Fir Fort Collins CO 80524 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 C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ,acoFrra`' ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMEDINSURED Arthur J. Gallagher Risk Management Services, Inc. FIRST STUDENT, INC. 600 Vine St Ste 1400 POLICY NUMBER CINCINNATI OH 45202 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Jeld are shown as additional insureds solely with respect to the General and Auto liability as evidence herein s required by written contract with respect to work performed by the named insured. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD