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HomeMy WebLinkAboutFIRST STUDENT INC - INSURANCE CERTIFICATE (11)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM(DDIYYYY) F,2/19/2017 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 endorsements . PRODUCER CONTACT NAME: Tanya D. Stephenson Arthur J. Gallagher Risk Management Services, Inc. i"moo EYu_ 212 994 7085 (FAX Nol: 212 994 7047 250 Park Avenue — 3rd Floor ADDRESS, Tanya_Stephenson@ajg.com New York NY 10177 INSURER(S) AFFORDING COVERAGE NAIC e INSURED FIRST STUDENT, INC. 600 Vine St Ste 1400 CINCINNATI OH 45202 INSURER A: National Union Fire Insurance INSURER B:New Ham shire Insurance Co INSURER c:American Home Assurance Ci r nvPDA(IFC CFATIFI(_ATF' NI IMRFR• 228181760 RF\/ICInNI NIIMRFR- of 19445 23841 19380 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. ILTRR TYPE OF INSURANCE NSD WVD I POLICY NUMBER OLICY EFF PMIDDNYYY POLICY P MMIDDNY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 3629890 12/31/2017 12/31/2018 EACH OCCURRENCE $5,000,000 CLAIMS -MADE 7 OCCUR PREMISESOEa occurrence $5,000,000 X MED EXP (Any one person) E Abuse and X Molestation Ind PERSONAL & ADV INJURY $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 POLICY X JERCOT a LOC PRODUCTS - COMP/OP AGG $5,000,000 E OTHER: A A A AUTOMOBILE LIABILITY ANY AUTO CA1921809 CA1921810 (MA) CA1921808 (VA) 12/31/2017 12/31/2017 12/31/2017 12/31/2018 12/31/2018 12/31/2018 COMBINED $5,000,000 X BODILY INJURY (Per person) E BODILY INJURY (Per accident) E OWNED SCHEDULED AUTOS ONLY AUTOS X ,__ HIRED NON -OWNED AUTOS ONLY �X AUTOS ONLY PROPERTYDAMAGE Peraccident E E UMBRELLA LIAB OCCUR EACH OCCURRENCE HCLAIMS-MADE AGGREGATE EXCESS LIAB E DED I I RETENTION E E B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE WC014649551 (AOS,GA,OR) WC014649558(MN) WC014649547 (FL) 12/31/2017 12/31/2017 12/31/2017 12/31/2018 12/31/2018 12/31/2018 X STATUTE ORH E.L. EACH ACCIDENT $5,000,000 B C B OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NSA WC014649549(MA,WI) WC014649548 (CA) WC 014649559 (ME) 12/31/2017 12/31/2017 12/31/2017 12/31/2018 12/31/2018 12/31/2018 E.L. DISEASE - EA EMPLOYE _ $5,000,000 E5,000,000 E.L. DISEASE -POLICY LIMIT I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Compensation: Policy #: WC 014649550 (AK, AZ, IL, KY,NC, NH, NJ, PA, UT, VA, VT) Policy Term: 12/31/17 to 12/31/18 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NFRMPO Transit Service THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 North Mason Street - 2nd. Flr ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80524 USA AUTHORIZED REPRESENTATIVE 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4CORO AGENCY CUSTOMER ID: LOC #: L nn1TI()N01 RFMAPVq C(_1-IFI1111 F Paae 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, Inc. NAMEDINSURED FIRST STUDENT, INC. 600 Vine St Ste 1400 CINCINNATI OH 45202 POLICY NUMBER 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 Weld are shown as additional insureds solely with respect to the General and Auto liability as evidence herein as 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