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HomeMy WebLinkAboutGreyhound Lines - 2001 Agreement - Amendment No. 1Cttp 1 O 11 7351 Rosanna Street Z ' ° ��. Gilroy, �,. • GR'�rED MPRG� Telephone (408) 846 -0400 Facsimile (408) 846 -0500 http://www.ci.gilroy.ca.us AMENDMENT TO THE SUBLEASE BETWEEN CITY OF GILROY AND GREYHOUND LINES, INC DATED JUNE 1, 2001 AMENDMENT NO.1 This Amendment shall become effective when it has been signed by the City Administrator and Greyhound Lines, Inc. All copies forwarded to Greyhound Lines Inc., for signature shall be returned to the City of Gilroy properly filled out. Upon acceptance by the City, Greyhound Lines Itic's copy will be returned. This Amendment is the first of three options which extend the five (5) year term of the Sublease between the City of Gilroy and Greyhound Lines, Inc., dated June 1, 2001. The commencement date is June 1, 2006 to May 31, 2011, as stated in section 3.5 Extended Term, of the original sublease dated June 1, 2001. The Monthly Rent will remain at $650 for this first five (5) year term. The second and third extended term base rents will be negotiated as stated in Section 4 of the original Sublease dated June 1, 2001. All requirements of the original Agreement Documents shall apply to the above work except as specifically modified by this Amendment. The contract tirne shall not extend unless expressly provided for in this Amendment. Greyhound Lines, Inc hereby agrees to make the above changes subject to the tenns of this Amendment as subtenant who leases the portion of the Depot Building, commonly known as 7250 Nlonterey Road, Gilroy, California. hound Lines, Inc By Date rd ✓ 1 r. lr,A^ ACCEPTI=D: - ---- - - - - -� �1i� Su s r, City Admints rator Date ,v P526oe28002 ACORO® D12 /14 /2012 ) � CERTIFICATE OF LIABILITY INSURANCE 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 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 endorsement(s). 1- 212 - 994 -7100 CONTACT Tanya D. Stephenson PRODUCER NAME: _ _ Arthur J. Gallagher Risk Management Services, Inc. PHONE 212 - 994 -7085 -- - FAX , No ) : 2127994 -7047 (A/C, No, Ext): JAIC E -MAIL 250 Park Avenue ADDRESS: Tan a_Ste henson @a' com Y P 74• -- 3rd Floor - New York, NY 10177 - INSURER(S) AFFORDING COVERAGE NAIC A _ INSURERA: INSURANCE. CO OF THE STATE OF PA 119429 INSURED INSURERB: NATIONAL UNION FIRE INS CO OF PITTS 419445 Greyhound Lines, Inc. INSURER C: ILLINOIS NATL INS CO 23817 350 N. St. Paul Street INSURERD: COMMERCE & INDUSTRY INS CO 19410 INSURER E: NEW HAMPSHIRE INS CO 123841 Dallas, TX 75201 - - - -- - - 9ncnincS DCVICIflfd N11MRPR- V V V Crl^V GJ 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, 'I ERM 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. _. -- _ -i - - - -' I INSR LIMITS 11 WVD TYPE OF INSURANCE INSR POLICY NUMBER MM DDYYYY MMIDD YYYY LA GENERAL 12 /31/ 13II IGL949389 12/31/1 ' EACH OCCURRENCE $ 5,000,000 DAMAGE TO RENTED - 5,000,000 $ X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrenceZ r. 1 _ - - -- - r --. CLAIMS -MADE R- III OCCUR MED EXP (Any one person) $ 50,000 _ PERSONAL &ADV INJURY $ 5,000, 000 iGENERALAGGREGATE t$ -__. 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COI P /OP AGG $ 5,000,000 PRO- j LI POLICY LOC II, 1 $ B AUTOMOBILE LIABILITY CA949249(VA)* 12/31/12 12/31/13 COMBINED SINGLE LIMIT 5,000,000 (Ea accident)_ __ -_- $ -. C CA949248 (TX)* 12/31/1 12/31/13'', BODILY INJURY (Per person) $ X ANY AUTO B SCHEDULED i CA949247(AOS) 12 31/14 / 12/31/13 - f BODILY INJURY (Per accident) $ ALL OWNED -- � NON -OWNED X X - - - PROPERTY DAMAGE $ I HIRED '! i AUTOS �-� _(Per accident) $ UMBRELLA LIAB D 'X I X OCCUR 13273459 I 12/31/1 2 12/31/131 EACH OCCURRENCE 2,000,000 $ LIA CLAIMS -MADE AGGREGATE $ 2,000,000 ---- -__ ) _ DEDESS RETENTION $ _ -- $ WORKERS COMPENSATION 1705101(WI), 1705095(FL) E 1 12/31/1 WC STATU- OTH- 12/31/13 R TORY LIMITS _ER ANDEMPLOYERS'uABOITY ANY PROPRIETORIPA 1 )12/31/1 12/31/13 E.L. EACH ACCIDENT i$ 5,000,0 - IWC1705104IIAOS),1705099(C in NH I 1705104(AOS),1705100(IL, ODESCR )12 /31/1 12/31/131 E.L. DISEASE EA EMPLOYEE $ 5,000,000 E(Mandatory DESCRIPTION OF OPERATIONS below 1' 11705096 (OR), 1705097(TX) 12/31/12 124 DISEASE - POLICY LIMIT $5,000,000 E 'Workers Compensation II44216119(MA)44216118(MN) 12/31/171 12 /31 /13,E.L. Each Accident 5,000,000 E.L. Disease -Ea Emp5,000,000 IE.L. Disease- Policy5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Gilroy, its officers, representatives, agents and employees are included as additional insured(blanket end't) solely with respect to General and Automobile liability coverages as evidenced herein on a primary /non - contributory basis as required by written contract with respect to Lease Agreement. A waiver of subrogation applies as required by written contract. Notice of Cancellation: 30 days written notice /10 days for non -pay UhK I II-IUA I t tiULUtK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 USA L U lytSO -LUIU AL:VKU I,VKrVKAr1%JN- An nyma raaarvau. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD anupny 30671065 s'� t w O N 00 7 W Pi2aw2aee2 S A�R"® CERTIFICATE OF LIABILITY INSURANCE I DATE 12 /16IDD/13 12/16/2013 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 pollcy(ies) must 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 endorsement(s). PRODUCER 1- 212 - 994 -7100 Arthur J. Gallagher Risk Management Services, Inc. 250 Park Avenue 3rd Floor New York, NY 10177 _ INSURED -- - Greyhoaad Linea, Inc. 350 N. St. Paul St. Dallas, TX 75201 CONTACT Tanya D. Stephenson PHONE fAX . 212 -994 -7100 x•212- 994 -7047 E-MAIL ADDRESS: TanYa_Stay32en0011609-- INSURE S AFFORDING COVERAGE NAM; • INSURERA: 118URANCB CO OF THE STATE OF PA 19429 INSURERS: NATIONn ONION FIRE INS CO OF PITTS 19445 INSURERC:MEN HAIIPSE1211 INS CO 23841 INSURER D: INSURERE: 12/31/1 INSURER F: EACH OCCURRENCE COVERAGES CERTIFICATE NUMRFR! 37347900 RFVISIAM MIIIIMRFR- 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. a18R TYPE OF INSURANCE SUER POLICY NUMBER POLICY EFF Y POLICY EXP M D LIMITS A GENERAL LIABILITY GL949389 12/31/1 12/31/14 EACH OCCURRENCE s 5,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE lxl OCCUR �MISEE O (WN—T-D- nce] e $5,000,000 MED EXP (Any one person = 50.000 PERSONAL d ADV INJURY $5,000,000 GENERAL AGGREGATE f 10,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $5,000,000 POLICY F PRO- Y LOC $ • e B A AUTOMOBILE Y LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CA949248 (AOS) CA4882243 (MA) CA949248(TY) CA4882242(VA) 12/31/1 12/31/1 12/31/1 12/31/14 12/31/14 12/31/14 COMBINED SINGLE LIMB E accident) 5,000,000 BODILY INJURY (Pr parson) f BODILYINJURY(Peraccident) i PROPERTY DAMAGE Per : UMBRELLA LIAB OCCUR EACH OCCURRENCE f AGGREGATE Z EXCESS LIAR CLAIMS -MADE DED I I RETENTION f C C AND EMPLOYERS' LIABILITY WORKERS COMPENSATION ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ NIA 1705096(OR), 1705097(TY) NC1705104 (AOS) ,1705099 ( 12/31/1 ) 12/31/1 12/31/14 12/31/14 X WCSTATI- OH. LIMITS TORY L. E. EACH ACCIDENT $ 5,000,000 El.DLSEASE - EAEMPLOYE $ 5,000,000 C (Mandatory In NH) 1705101(trI), 1705095(FL) 12/31/1 12/31/14 C If yes descrbeunder DESCRIPTION OF OPERATIONS bebw 1705104(AOS) 11/31/1 12/31/14 E.L. DISEASE - POLICY LIMIT 1 $ 5, 000, 000 C workers Compensation 44216119(NA)44216118(NN) 12/31/1 12/31/14 B.L. Each Accident 5,000,000 C Workers Compensation 1705100 (IL,NC,NH,UT,VT) 12/31/1 12/31/14 B.L. Disease -BA Eotp5,000,000 B.L. Disease- Policy5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The Certificate Holder is included as Additional Insured as required by written contract subject to policy terms, conditions and exclusions. City of Gilroy Attn: Mike Dorn 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2010105) ankurny 37347900 \,ANUMLLA 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 _ USA C' ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD N u. O 91 z W P5260028002 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS R EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 FA (MMIDD/YY1'Y) A� V CERTIFICATE OF LIABILITY INSURANCE (MMI2013 TYPE OF INSURANCE DL SUER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS POLICY EFF MMMD 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 GENERAL LIABILITY REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 0 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to 12/31/1 the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the EACH OCCURRENCE certificate holder In lieu of such endorsement(s). PRODUCER 1 -212- 994 -7100 CONTACT Tana D. Stephenson y Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX INC. Et,m 212- 994 -7085 212- 994 -7047 250 Park Avenue E-MAIL ADDRESS: Taaya_StepheneonLaajg.com $ 5,000,000 3rd Floor $ 50,000 New York, NY 10177 INSURER IS) AFFORDING COVERAGE NAIL i $ 5,000,000 INSURERA: INSURANCE CO OF THE STATE OF PA 19429 INSURED INSURER B: NATIONAL UNION FIRE INS CO OF PITTS 19445 Greyhound Lines, Inc. INSURERC: COWWCE A INDUSTRY INS CO 19410 350 N. St. Paul Street INSURER D: NON HAMPSHIRE INS CO 23841 GENERAL AGGREGATE Dallas, TX 75201 INSURER E: _ INSURER F: COVFRAGFS CFRTIFICOTF NIIMRFR• 37461015 RFVIRInN NIIhIIRFR- 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 DL SUER POLICY NUMBER POLICY EFF MMMD POLICY EXP MMDIYYYY1 LIMITS A GENERAL LIABILITY GL949389 12/31/1 12/31/14 EACH OCCURRENCE $ 5,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR DAMAGE PREMISES S ( Ea oa RENTED urrence) $ 5,000,000 MED EXP (Any one person) $ 50,000 PERSONAL & ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 10,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 5,000,000 POLICY PRO- 21 LOC $ B A B AUTOMOBILE X UAINUTY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CA949248 (AOS) CA4882242(VA) CA949248(TX) 12/31/1, 12/31/1 12/31/1 12/31/14 12/31/14 12/31/14 COMBINED SINGLE LIMIT Ea accident 5,000,000 BODILY INJURY (Par person) $ BODILY INJURY (Per accident) $ X NON-OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ _ $ C UMB�LALIAIS E OCCUR 20562327 12/31/1 12/31/14 EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 4DED EXCESS LIAR CLAIMS -MADE RETENTIONS $ • D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ❑ NIA 1705104(AOS) 1705101(WI), 1705095(FL) 12/31/1 12/31/1 12/31/14 12/31114 g WCSTATU- OTH E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPL2n4 $ 5,000,000 • (Mandatory 1. NH) 1705096(OR), 1705097(TX) 12/31/1 12/31/14 D It yes desc be under DESCRIPTION OF OPERATIONS below WC1705104(AOS),1705099( ) 12/31/1 12/31/14 E.L. DISEASE - POLICY LIMIT 1 $ 5, 000, 000 • Workers Compensation 44216119(NA)44216118(MN) 12/31/1 12/31/14 S.L. Each Accident 5,000,000 • Workers Compensation 1705100(IL,NC,NH,UT,VT) 12/31/1 12/31/14 E.L. Disease -Ea Emp5,000,000 E.L. Disease- Policy5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) City of Gilroy, its officers, representatives, agents and employees are included as additional insured(blanket end•t) solely with respect to General and Automobile liability coverages as evidenced herein on a primary /non - contributory basis as required by written contract with respect to Lease Agreement. A waiver of subrogation applies as required by written contract. Notice of Cancellation: 30 days written notice /10 days for non -pay l.rm 1Irit RkIC rIULUCK City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2010/05) vinayny 37461015 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 USA — ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P52UX)2H(X12 ACORO� L AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMEDINSURED Arthur J. Gallagher Risk Management Services, Inc. Greyhound Lines, Inc. 350 N. St. Paul Street POLICY NUMBER Dallas, TX 75201 CARRIER NAIC CODE EFFECTIVE DATE: KCIVIA NR THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Workers Compensation: - Policy #: 62790765 (AZ, GA) & 62790767 (NJ, PA)- Policy Term: 12/31/13 to 12/31/14 - Carrier Name: NEW HAMPSHIRE INS CO (NAIC #:23841) - Limits: E.L. Each Accident / E.L. Disease -Ea Employee / B.L. Disease- Policy Limit - $5,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD x r W P52W)2 81X12 Aco CERTIFICATE OF LIABILITY INSURANCE D 12 /19 IDD/ 12/19/2013 13 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS INSR I TYPE OF INSURANCE ADOL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD A 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 12/31/1 12/31/14 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. $ 5,000,000 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to X COMMERCIAL GENERAL LIABILITY r 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 endorsement(s). $ 5, 000, 000 PRODUCER 1- 212 - 994 -7100 Arthur S. Gallagher Risk Management Services, Inc. CONTACT Y NAME: Tan a D. Stephenson 00 PHONE No: PHN,Exti 212- 994 -7100 - FAX 212- 994 -7047 E-MAIL ADDRESS: Tn a_Ste hnsonea jg•com 250 Park Avenue 3rd Floor z W PERSONAL 8 ADV INJURY $ 5,000,000 New York, NY 10177 INSURERS AFFORDING COVERAGE NAIC # __ _. ,_ INSURERA: INSURANCE CO OF THE STATE OF PA 19429 _ GENERAL AGGREGATE INSURER B: NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURED Greyhound Lines, Inc. GENT AGGREGATE LIMIT APPLIES PER: INSURER C: NEW HAMPSHIRE INS CO 23841 INSURER D: 350 N. St. Paul St. INSURER E: POLICY PRO- JECT X LOC Dallas, TX 75201 INSURER F: • A • • AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS rnVFRAr.FS rFRTIFIrOTF NIIMRFR• 37458794 RFVISInN NIIMRFR- CA949248(AOS) CA4882242 (VA) CA949248(TX) CA4882243 (MA) 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 I TYPE OF INSURANCE ADOL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY GL949389 12/31/1 12/31/14 EACH OCCURRENCE $ 5,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 5, 000, 000 CLAIMS -MADE [ X I OCCUR MED EXP (Any one person) $ 50,000 PERSONAL 8 ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 10,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 5,000,000 POLICY PRO- JECT X LOC $ • A • • AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CA949248(AOS) CA4882242 (VA) CA949248(TX) CA4882243 (MA) 12/31/11 12/31/1 12/31/1 12/31/1 12/31/14 12/31/14 12/31/14 12/31/14 COMBINED SINGLE LIMIT 5,000,000 BODILY INJURY(Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS IJAB CLAIMS -MADE $ DED RETENTIONS C C WORKERS COMPENSATION AND EMPLOYERS' LUIBILITY ANY PROPRIETORIPARTNER/EXECUIIVE YIN 1705104(AOS) 1705101(WI), 1705095(FL) 12/31/1 12/31/1 12/31/14 12/31/14 X WC SLi 0TH- E.L. EACH ACCIDENT $ 5,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ 5,000,000 C (Mandatory In NH) 1705096(OR), 1705097(TX) 12/31/1 12/31/14 C It yes,describeunder DESCRIPTION OF OPERATIONS below WC1705104(AOS),1705099( 112/31/1 12/31/14 E.L. DISEASE - POLICY LIMIT $ 5,000,000 C Workers Compensation 44216119(MA)44216118(MN) 12/31/1 12/31/14 E.L. Hach Accident 5,000,000 C Workers Co eneation 1705100 (IL,NC,NH,UT,VT) 12/31/1 12/31/14 H.L. Disease -EA Emp5,000,000 H.L. Disease- Policy5,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is nsqulrsd) The Certificate Holder is included as Additional Insured as required by written contract subject to policy terms, conditions and exclusions. L.CRI Irn.A Ic nULUCR I.AIY t.CLLAIIVIV City of Gilroy Attn: Mike Dorn 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2010105) vinayny 37458794 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 _ USA ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P520(X)28IX12 ACOR" AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page Of AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, Inc. Greyhound Lines, Inc. 350 N. St. Paul St. POLICY NUMBER Dallas, TX 75201 CARRIER NAIC CODE EFFECTIVE DATE: AUUI I IUNAL HtMAMKJ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Workers Compensation: - Policy #: 62790765 (AZ, GA) & 62790767 (NJ, PA)- Policy Term: 12/31/13 to 12/31/14 - 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 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4 v L�. 0 N 00 00 r z w