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HomeMy WebLinkAboutFIRST TRANSIT INC - INSURANCE CERTIFICATE (6)DATE (MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 12/17/2015 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 3rd Floor E-MAIL . Tanya_Stephenson@ajg.com _ New York NY 10177 INSURER(S)AFFORDING COVERAGE NAICN INSURED FIRST TRANSIT, INC. 600 Vine Street, Suite 1400 Cincinnati. OH 45202 INSURER A: Insurance Company of State of PA 19429 INSURERS: National Union Fire Insurance Coma 19445 INSURERc:New Hampshire Insurance Company 23841 INSURER D : CnX1FRACCFR CFRTIFICATF NIIMRFR• 883556352 RF1/ICI( pj NIIRARFR- 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 I TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MWDDIYYYY POLICY EXP LIMITS MIDD/YYYY A X COMMERCIAL GENERAL LIABILITY GL 173-79-23 (IOMM AGG) 12/31/2015 12/31/2016 EACH OCCURRENCE $5,000,000 CLAIMS -MADE � OCCUR RENTE PREMISES Ea occurrence $5,000,000 MED EXP (Any one person) S PERSONAL & ADV INJURY $5,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 POLICY 1 PE0 a LOC PRODUCTS - COMPIOP AGG $5,000,000 $ 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 12/31/2016 12/31/2016 OMBI dent $5,000,000 X BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED HIRED AUTOS X NON -OWNED AUTOS X RTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTIONS E C C C C C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA WC1178531(IL,NC,NH,UT,VT) WC001178529 (CA) WC001178583 (AOS) WC44216118(MN) WC001178527 (FL) WC001178530 (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 12/31/2016 12/31/2016 12/31/2016 X STATUTE ER E.L. EACH ACCIDENT $5,000,000 E.L. DISEASE - EA EMPLOYEE $5_,000,000 E.L. DISEASE - POLICY LIMIT $5,000,000 i i DESCRIPTION OF OPERATIONS I 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. Flr 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 4�'ORO AGENCY CUSTOMER ID: LOC #: annirilnN011 oruap (C C('_wrni ii r AGENCY Arthur J. Gallagher Risk Management Services, Inc. POLICY NUMBER CARRIER NAIC CODE NAMEDINSURED FIRST TRANSIT, INC. 600 Vine Street, Suite 1400 Cincinnati, OH 45202 EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE 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 Pane , of gGUKU lul (ZUUB/Ul) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD