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Home My WebLink AboutCOI - Greyhound Lines, Inc. - Expires 2018-12-31CORD® ACERTIFICATE OF LIABILITY INSURANCE �....----" DATE(MM/DO/YYYY) 12/27/2017 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 ri . hts to the certificate holder in lieu of such endorsement s . PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 250 Park Avenue 3rd Floor New York NY 10177 CO A N Tanya D. Stephenson PHONE FAX ice NoE ; 212-9947085 (A/C. No)_ 212-994-7047 t ass,Tanya Stephenson@ajg.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :National Union Fire Insurance Company of 19445 INSURED Greyhound Lines, Inc. 350 N. St. Paul St. Dallas, TX 75201 INSURER B :New Hampshire Insurance Company 23841 INSURER C :American Home Assurance Company 19380 INSURER D :Commerce and Industry Insurance Company 19410 INSURER E : INSURER F : COVERAGES 810916864 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 AUUL INSD SLASH WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) UMRS A x COMMERCIAL GENERAL LABILITY GL 3629887 12/31/2017 12/31/2018 EACH OCCURRENCE S5,000,000 CLAIMS -MADE U OCCUR PREMISES (Ea occurrence) S5,000,000 MED EXP (Any one person) S PERSONAL & ADV INJURY S5,000,000 GEN'L AGGREGATE X LIMIT APPLIES PER: JEC X LOC GENERAL AGGREGATE S 10,000,000 PRODUCTS - COMP/OP AGG S5,000,000 S A A A AUTOMOBILE X X - LABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY CA 1921794(AOS) CA1921795(MA) CA1921798 (VA) 12/31/2017 12/31/2017 12/31/2017 12/31/2018 12/31 /2018 12/31/2018 COMBINED SINGLE LIMIT (Ea accident) s 5,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) s S D X UMBRELLA LAB EXCESS UAB X OCCUR CLAIMS -MADE 28189402 12/31/2017 12/31/2018 EACH OCCURRENCE $2,000,000 AGGREGATE s2,000,000 DED RETENTION $ $ B C B B B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY V / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? n (Mandatory In NH) It yes. describe under DESCRIPTION OF OPERATIONS below N / A WC 014649556 (AOS,GA) WC 014649553 WC 014649552 (CA)FL) WC 014649557 MN) WC 014649555 (WI,MA) 12/31/2017 12/31/2017 12/31/2017 12/31/2017 12/31/2017 12/31/2018 12/31/2018 12/31/2018 12/31/2018 12/31/2018 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $5,000,000 E.L. DISEASE - EA EMPLOYEE $5,000,000 E.L. DISEASE " POLICY LIMIT $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) Workers Compensation: Policy #: WC 014649550 (AZ,IL,KY,NC,NJ,PA,UT,VA,VT) Policy Term: 12/31/17 to 12/31 /18 Carrier Name: NEW HAMPSHIRE INS CO (NAIC #:23841) Limits: E.L. Each Accident I E.L. Disease -Ea Employee / E.L. Disease -Policy Limit - $5,000,000 See Attached... CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street GSAy CA 95020 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 ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: D� AC ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, Inc. NAMED INSURED Greyhound Lines, Inc. 350 N. St. Paul St. Dallas, TX 75201 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE 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 ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AcoRL CERTIFICATE OF LIABILITY kle..„.'"--. INSURANCE DATE(MMIDDIYYYY) 12/27/2017 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE 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 endorsement(s). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 250 Park Avenue 3rd Floor New York NY 10177 CONTACT NAmE: Tanya D. Stephenson iA c° Fes)_ 212-994-7085 • No): 212-994-7047 E-MAIL ADnREss: Tanya_Stephenson@ajg.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :National Union Fire Insurance Company of 19445 INSURED Greyhound Lines, Inc. 350 N. St. Paul St. Dallas, TX 75201 INSURER B :New Hampshire Insurance Company 23841 INSURER C :American Home Assurance Company 19380 INSURER D :ACE Property & Casualty Insurance Co 20699 INSURER E :Commerce and Industry Insurance Company 19410 INSURER F : COVERAGES ERTIFICATE NUMBER: 1101420927 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, PAID CLAIMS INSR LTA TYPE OF INSURANCE AUUL IN$D SLUSH WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP IMM/DINYYYY) LI A X COMMERCIAL GENERAL LABILITY GL 3629887 12/31/2017 12/31/2018 EACH OCCURRENCE $5,000,000 CLAIMS -MADE X OCCUR DAMAGE TO PREMISES (Ea occuED ence) $5,000,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY S5,000,000 GEM_ AGGREGATE X LIMIT APPLIES PER: EC X LOC GENERAL AGGREGATE S 10,000,000 PRODUCTS - COMP/OP AGO $5,000,000 $ A A A AUTOMOBILE X X LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS NON -OWNED AUTOS ONLY CA 1921794(AOS) CA 1921795(MA) CA1921796 (VA) 12/31/2017 12/31/2017 12/31/2017 12/31/2018 12/31/2018 12/31/2018 OMBBINdEED SINGLE LIMIT ) $5,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per sodden')S S E X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 28189402 12/31/2017 12/31/2018 EACH OCCURRENCE $25,000,000 AGGREGATE S25,000,000 DED RETENTION $ $ B C B g B WORKERS COMPENSATION AND EMPLOYERS' LIAB�.ITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N _ N / A WC 014649556 (AOS,GA) WC 014649553 WC 014649552 (CA)FL) WC 014649557 (MN) WC 014649555 WI,MA) 12/31/2017 12/31/2017 12/31/2017 12/31/2017 12/31/2017 12/31/2018 12/31 /2018 12/31/2018 12/31/2018 12/31/2018 X STATUTEPER TRH. E.L. EACH ACCIDENT S5,000,000 E.L. DISEASE . EA EMPLOYEE $5,000,000 E.L. DISEASE - POLICY LIMIT $5,000,000 D Excess Liability G46844245 001 12/31/2017 12/31/2018 $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) Workers Compensation: Policy #: WC 014649550 (AZ,IL,KY,NC,NJ,PA,UT,VA,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 - $5,000,000 See Attached... CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street Gilroy CA 95020 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: J 0 ,-- 0 03 a. J W V♦ cc Q 2 W J Q Z 0 I a NAMED INSURED Greyhound Lines, Inc. 350 N. St. Paul St. Dallas, TX 75201 EFFECTIVE DATE I AGENCY Arthur J. Gallagher Risk Management Services, Inc. POLICY NUMBER W 8 Q uJ I 4 U I FORM NUMBER: 25 a ^.oa) C.0 a)•i Q C '' L x80 N (2•a) O ctS �Ec Ego a O ird pot O i w co O _a) .0 > -DUO �o3 m ova OWC) `DOE a) a) m co o!< n(1) a) E$a)0)al o a�)a)0. c�6 o y vi a)E. a� NO3c O O C a) a)m L° OUQ 0. - A. 0 C9•30)U .. O a0 y >.o•v-, (1o)�3 Notice of Cancellation: 30 days written notice/10 days for non -pay 0 L 0 co z 0 0 a 0 0 CC 0 C .) N The ACORD name and logo are registered marks of ACORD