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HomeMy WebLinkAboutFIRST STUDENT INC - INSURANCE CERTIFICATE (13)A! `C>R" ® DATE (MMIDD/YYYY) V 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 NAME: Tanya D. Stephenson Arthur J. Gallagher Risk Management Services, Inc. PHONE 212-994 7085 FAX 250 Park Avenue (A/C,212 994-7047 Nn- 3rd Floor AMAIL .Tanya_Stephenson@ajg.com New York NY 10177 INSURER(S)AFFORDING COVERAGE NAIC t INSURED FIRST STUDENT, INC. 600 Vine St Ste 1400 CINCINNATI OH 45202 INSURERA:National Union Fire Insurance Compa 19445 INSURER B:New Hampshire Insurance C_Ompaa9y _ 23841 INSURERc:American Home Assurance Company 19380 INSURERD: INSURERE: rnllroariG'C r CDTwirATC KitIRARCD• 117F991QA7 orvlclnAl eutRADrn. 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. -- ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER F POLICYONYYY POLICY MWIDDNY P LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR GL 3629890 (10MM AGG) 12/31/2016 12/31/2017 EACH OCCURRENCE _ -DAMKPREGETO�ENTED MISESjEa occurrence $5,000,000 $5,000,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $5,000,000 GEN'L PPOLICY AGGREGATE LIMIT APPLIES PER: 7 PRO- LOC GENERAL AGGREGATE $10,000,000 PRODUCTS - COMP/OP AGG $5,000,000 $ OTHER: A q q AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON OWNED AUTOS ONLY X AUTOS ONLY CA1921809 AOS ( ) CA19218(MA) CA1921808 08 (VA) 12/31/2016 12/31/2016 12l3112016 12/31/2017 12/31/2017 12/31I2017 Ea accident $ 5,000,000 X _ BODILY INJURY ( Per person) $ BODILY INJURY (Per accident) E X _W0P=DAA1 GE_ Per accident_ $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ B B B B B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC 014649551 (AOS, GA) 12/31/2016 WC01 4649558 (MN) 12/31/2016 WC014649547 (FL) 12/31/2016 WC014649551 (TX) '.12/31/2016 WC014649549 (MA, WI) 12/31/2016 WC014649548 (CA) I12/31/2016 i 12/31/2017 12/31/2017 12/31/2017 12/31/2017 12/31/2017 12/31/2017 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 it i DESCRIPTION OF OPERATIONS / LOCATIONS / 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 NFRMPO, the cities of Greeley, Loveland, and Johnstown and the Counties of Larimer and Weld are shown See Attached... %,r K I Ir 11L.A 1 t f-IVLUtK LANLtLLA I IUN NFRMPO Transit Service 215 North Mason Street - 2nd. Fir 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 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ACOR" 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: rm. 11"L61c1-11 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE as additional insureds solely with respect to the General and Auto liability coverages as evidenced 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