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HomeMy WebLinkAboutFIRST TRANSIT INC - INSURANCE CERTIFICATE (9)ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 FAXVC. 212 994 7047 250 Park Avenue 3rd Floor E-MAIL . Tanya_Stephenson@ajg.com New York NY 10177 INSURER(S)AFFORDING COVERAGE NAICM INSURED FIRST TRANSIT, INC. 600 Vine Street, Suite 1400 Cincinnati, OH 45202 INSURER A: National Union Fire Insurance Coma 19445 INSURERB:New Hampshire Insurance Company 23841 INSURER C: American Home Assurance Company --�-- 19380 INSURERD: INSURER E nnVFRACCFS rFRTIFICATF NIIMRFR• 1067003264 RFVISION NIIMRFR- 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 WV POLICY NUMBER POLICY EFF MIDDNYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL 3629890 (10MM AGG) 12/31/2016 12/31/2017 EACH OCCURRENCE $5,000,000 CLAIMS -MADE Li I OCCUR -DAMAGE TO RENTED — PREMISES Ea occurrence $5,000,000 ME EXP (Any one person) $ PERSONAL & ADV INJURY $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 POLICY PE� � FX] LOC PRODUCTS - COMP/OP AGG $5,000,000 $ OTHER: A A A AUTOMOBILE LIABILITY X ANY AUTO CA1921809 (AOS) CA1921810 (MA) CA1921808 (VA) 12/31/2016 12/31/2016 12/31/2016 12/31/2017 12/31/2017 12/31/2017 Ea accident) — $5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON OWNED X AUTOS ONLY X AUTOS ONLY 0PrM7DAMAGE_ Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS AGGREGATE $ EXCESS LIAB MADE DIED RETENTION $ $ B B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE WC 014649551 (AOS, GA) WC014649558 (MN) WC014649547 (FL) 12/31/2016 12/31/2016 12/31/2016 12/31/2017 12/31/2017 12/31/2017 X OTH- STATUTE ER E.L. EACH ACCIDENT $5,000,000 B B C OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC014649551 (TX) WC014649549 (MA,WI) WC014649548 (CA) 12/31/2016 12/31/2016 12/31/2016 12/31/2017 12/31/2017 12/31/2017 E.L. DISEASE - EA EMPLOYE 55,000,000 E.L. DISEASE - POLICY LIMIT %5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare 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... 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 80.524 USA 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 #: ACa ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, Inc. NAMED INSURED FIRST TRANSIT, INC. 600 Vine Street, Suite 1400 Cincinnati, OH 45202 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: 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. The General liability policy form evidenced herein includes a Separation ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD