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HomeMy WebLinkAbout465554 GREYHOUND LINES INC - INSURANCE CERTIFICATE (9)AC� ® DATE (MM/DDt YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/20/2017 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 . ACT PRODUCER NAME: Tana D. Stephenson Arthur J. Gallagher Risk Management Services, Inc. PHONE 212 994 7085 FAX 212 994 7047 3rd Park Avenue E-MAIL . Tana Ste henson@a 3rd Floor Y — P .1g•com New York NY 10177 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Greyhound Lines, Inc. 350 N. St. Paul St. Dallas, TX 75201 INSURER A: New Hampshire Insurance CompaqCompaqy 23841 INSURER B: National Union Fire Insurance Company of 19445 INSURERc:American Home Assurance Comoanv 19380 INSURER E : r n%/FDAr:FC CFDTIFICATF IUI IMRFD- 1097F;F;g37.Ei DGVliZini111111 IRARGD• 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 INSD ,SUBRT-.--...._,_-.__ WVD' -- --�— -- POLICY NUMBER —POLICY EFF MM/DDIYYYY POLICY EXP MWDD/VYYY ' --- LIMITS B X COMMERCIAL GENERAL LIABILITY GL 3629887 12/31/2017 12/31/2018 EACH OCCURRENCE $5,000,000 CLAIMS -MADE FXI OCCUR DAMAGE TO RENTED__ PREMISES Ea occurrence) E5,000,000 ME EXP (Any one person) $ PERSONAL & ADV INJURY $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 POLICY a JE� � LOC PRODUCTS - COMP/OP AGG $5,000,000 S OTHER: I B B B - AUTOMOBILE LIABILITY ANY AUTO CA 1921794 (AOS) CA1921795(MA) CA1921796 (VA) 12/31/2017 12/31/2017 12/31/2017 12/31/2018 12/31/2018 12/31/2018 Ea aBINED SINGLE LIMIT ccident $5,000,000 - X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I ! RETENTION $ $ A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE WC 014649556 (AOS,GA) 12/31/2017 WC 014649555 (WI,MA) 12/31/2017 WC 014649552 (FL) 12/31/2017 12/31/2018 12/31/2018 12/31/2018 X OTH- STATUTE ER E.L. EACH ACCIDENT S5,000,000 A C OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC 014649557 (MN) 12/31/2017 WC 014649553 (CA) 12/31/2017 12/31/2018 12/31/2018 E.L. DISEASE - EA EMPLOYEE S5,000,000 E.L. DISEASE - POLICY LIMIT $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Workers Compensation: Policy #: WC 014649554 (AZ,IL,NC,NH,NJ, PA,UT,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 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P U Box 580, 117 North Mason Street ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80522 USA AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD