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HomeMy WebLinkAbout465554 GREYHOUND LINES INC - INSURANCE CERTIFICATE (7)DATE (MMIDD/YYYY) ACoRo® CERTIFICATE OF LIABILITY INSURANCE 12/16/2015 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 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�y. Tanya D.Stephenson PHONENo, . 212-994-7085 - FAX 212-994-7047 E-MAIL «. Tanya_Stephenson@aict.com F: Insurance Company of State of PA New Hampshire Insurance Compal National Union Fire Ins Co of Pitts Cr1\lFRat:FC CFRTIFICOTF IUI IRARFR• 1443230719 RFt/ICIn1U IUI IMRFR- 19429 23841 19445 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. INTSR R TYPE OF INSURANCE INSD S08 WVD POLICY NUMBER POLICY EFF MIDDIYY POLICY EXP MIODIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 094-93-89 12/31/2015 12/31/2016 EACH OCCURRENCE $5,000,000 PREMISES Ea occurrence $5,000,000 CLAIMS -MADE 1 X OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $5,000,000 GENT _ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 POLICY � ECT FX] LOC PRODUCTS - COMP/OP AGG $ 5,000,000 $ OTHER: C C A AUTOMOBILE LIABILITY X ANY AUTO CA 949248 (AOS) CA4584448 (MA) CA4584448 (VA) 12/31/2015 12131 /2015 12/31/2015 12/31/2016 12/31 /2016 12/31/2016 OME111accident)_$5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED AUTOSULED $ NON -OWNED HIRED AUTOS AUTOS Per accident $ E UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR DIED RETENTION $ $ B B B B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F-N (Mandatory in NH) IF yes, describe under DESCRIPTION OF OPERATIONS below NIA WC001705104(AOS) WC001705101 1) WC 001705095 (FL) WC 001705104 (OR) WC001705104 (TX) WC 001705099 (CA) 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 EMPLOYE $5,000,000 E.L. DISEASE - POLICY LIMIT $5,000,000 B B B Workers Compensation Workers Compensation Workers Compensation 1705100 (IL,NC,NH,UT,VT, WC044216117 (MN) WC001705101 (MA) 12/31/2015 12/31/2015 12/31/2015 12/31/2016 12/31/2016 12/31/2016 E.L. Each Accident 5,000,000 E.L. Disease -EA Emp 5,000,000 E.L. Disease -Policy 5,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Ir more space is required) Workers Compensation: Policy #: 1705104 (AZ,GA) & WC 001705100 (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 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. � CERTIFICATE HOLDER CANCELLATION City of Fort Collins P 0 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD