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Home My WebLink AboutFIRST STUDENT INC - INSURANCE CERTIFICATE (12)ACC> ® DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/21/2016 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 Tan NAME: ya D. Stephenson Arthur J. Gallagher Risk Management Services, Inc. PHONE 212 994 7085 FAX 250 Park Avenue (A/C.No.EIR): WC. Nor 212 994 7047 3rd Floor E-MAILIS. Tanya_ Stephenson@ajg.com New York NY 10177 INSURER(S) AFFORDING COVERAGE NAICI INSURER A: National Union Fire Insurance Compa 19445 INSURED INSURER B: New Hampshire Insurance Companyqqmpany 23841 FIRST STUDENT, INC. INSURER c: American Home Assurance Company 19380 600 Vine St Ste 1400 INSURER D: CINCINNATI OH 45202 INSURERE: rr1VFRAC;F4c. CFDTIFICATF N1111ARFD. RFiR31Fi9iR 1317111CInllt 1111 IRADEo. 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 WVD POLICY NUMBER POLICY EFF MIOD/YYYY POLICY EXP MID Y LIMITS A X COMMERCIAL GENERAL LIABILITY GL 3629890 (IOMM AGG) 12/31/2016 12/31/2017 EACH OCCURRENCE $5,000,000 CLAIMS -MADE J OCCUR _ TO RENTED PREMISES (Ea occurrence $5,000,000 ME EXP (Anon person) $ PERSONAL & ADV INJURY $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1 7X PEC LOC GENERAL AGGREGATE $10,000,000 PRODUCTS - COMP/OP AGG $5,000,000 $ OTHER: A A A AUTOMOBILE LIABILITY ANY AUTO CA1921809 (AOS) CA1921810 (MA) CA1921808 (VA) 12/31/2016 12/31/2016 12/31/2016 12/31/2017 12/311 12/31/2017 acc'NEI) SINGLE LIMIT ident Ea2017 $5,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY X 075_ERTy1}]WGE__— Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE_ $ AGGREGATE_ $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B B B B B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC 014649551 (AOS, GA) WC014649558(MN) WC014649547 (FL) WC014649551 (TX) WC014649549 (MA,WI) WC014649548 (CA) 12/31/2016 12/31/2016 12/31/2016 12/31/2016 12/31/2016 12I31/2016 12/31/2017 12/31/2017 12/31/2017 12/31/2017 12/31/2017 12/31I2017 X I IP STATUTE FOR E.L. EACH ACCIDENT S5,000,000 E.L. DISEASE - EA EMPLOYE $5,000,000 E.L. DISEASE - POLICY LIMIT $5,000,000 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, NC, NH, NJ, PA, UT, VT) Policy Term: 12/31/16 to 12/31/17 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... GERIIFICATE 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. Fir ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80524 USA AUTHORIZED REPRESENTATIVE C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: .aCo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED 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: I I IVIVAL KtMHKRJ 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. ACURIJ 101 (Z008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD