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AcOlf CERTIFICATE F LIABILITY INSURANCE DATE (MI -)
<br />13/25/2015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Arthur J. Gallagher Risk Management Services, Inc.
<br />250 Park Avenue
<br />3rd Floor
<br />New York NY 10177
<br />CONTACT
<br />NAME: Tanya D. Stephenson
<br />PHONE 212-994-7085 FA't 212-994-7047
<br />Xt):._ (A/C N®a
<br />E-MAIL Tana Ste henson a
<br />D��€ss. y _ p _ @ jg.com
<br />INSURER(S) AFFORDING COVERAGE MAIC #
<br />INSURER A: Insurance Company of State of PA 19429
<br />A
<br />INSURED
<br />INSURERB:New Hampshire Insurance Company 23841
<br />Greyhound Lines, Inc.
<br />350 N. St. Paul Street
<br />INSURERC:National Union Fire Ins Co Pittsbur 19445
<br />2/31/2014
<br />Dallas, TX 75201
<br />INSURER DL—
<br />INSURER E:
<br />MED EXP (Any one person) $
<br />INSURER F:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER.
<br />POLICY EFF
<br />MM/DD/YYYYl
<br />POLICY EXP
<br />fgMMP=
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />GL 0949389
<br />2/31/2014
<br />12/31/2015
<br />EACH OCCURRENCE $5,000,000
<br />DAMAGE TO RENTED
<br />PREMISESfEaoccurregce) $5_,000,000
<br />MED EXP (Any one person) $
<br />_
<br />PERSONAL &ADV INJURY $5,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRO -
<br />POLICY JECT [:X] ^ f LOC
<br />GENERAL AGGREGATE $10,000,000
<br />_
<br />PRODUCTS- COMP/OP AGG $5,000,000
<br />$
<br />OTHER:
<br />C
<br />A
<br />C
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED------
<br />AUTOSAUTOS
<br />CA 949248 (AOS)12/31/2014
<br />CA4882242 (VA)
<br />CA4584447(MA)
<br />12/31/2014
<br />12/31/2014
<br />12/31/2015
<br />12/31/2015
<br />12/31/2015
<br />Ee aBcSING deDtI $5,000,000
<br />60DILYINJURY (Per person) $
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />Per accident $
<br />$
<br />UMBRELLA LIZ—
<br />OCCUR
<br />EACH OCCURRENCE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $
<br />DED RETENTION $
<br />$
<br />B
<br />B
<br />A
<br />B
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS°LIABILITY Y/N
<br />ANY PROPRIETORPARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? FNIN
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I A
<br />WC001705104 (AOS)
<br />WC001705101 (WI)
<br />WC 001705095 (FL)
<br />WC 001705104 (OR)
<br />W0001705104(TX)
<br />WC 001705099 (CA)
<br />12/31/2014
<br />12/31/2014
<br />12/31/2014
<br />12/31/2014
<br />12131/2014
<br />12/31/2014
<br />12/31/2015X
<br />12/31/2015
<br />12/31/2015
<br />12/31/2015
<br />12131/2015
<br />12/31/2015
<br />B
<br />STATUTE ORH
<br />--
<br />E.L. EACH ACCIDENT_ $5,000,000
<br />_ _
<br />E.L. DISEASE - EA EMPLOYE" $5,00.0,000
<br />E.L. DISEASE - POLICY LIMIT $5,000,000
<br />B
<br />B
<br />B
<br />Workers CompensationWC44216118(MN)
<br />Workers Compensation
<br />WC001178530 (MA)
<br />1705100 (IL,NC,NH,UT,VT,
<br />12/31/2014
<br />12/31/2014
<br />12/3112014
<br />12/3112015
<br />12/31/2015
<br />12/31/2015
<br />E.L. Each Accident 51000,000
<br />E.L. Disease -EA Emp 5,000,000
<br />E.L. Disease -Policy 5,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Workers Compensation: GREYHOUND L]N INC 1 200 -028
<br />Policy #: 1705104 (AZ,GA) & WC 001705100 (NJ,PA) �,,
<br />Policy Term: 12/31/14 to 12/31/15 REVIEt�O/EI 13Y. r ,
<br />Carrier Name: NEW HAMPSHIRE INS CO (NAIL #:23841) F-UNICE HERED (PG 1 OF ;;
<br />Limits: E.L. Each Accident! E.L. Disease -Ea Employee / E.L. Disease -Policy Limit - $5,000,000
<br />See Attached...
<br />19.i4 i's II1LWfl:ltlt. OWUNku. 1
<br />City of Santa Aria
<br />c/o Public Works Agency/SARTC
<br />1000 Santa Ana Blvd,Suite#108
<br />Santa Ana CA 92701 USA
<br />REPRESENTATIVE
<br />(a 19bd-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />003541
<br />
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