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<br />L/ CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM0D1YYYY)
<br />1?+16/2015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE 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(ies) 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 Bear of such endorsement(s).
<br />PRODUCER
<br />Arthur J. Gallagher Risk Management Service's, Inc.
<br />250 Park Avenue
<br />3rd Floor
<br />CONTACT
<br />NAME: Tanya D, Stephenson
<br />PHONEFAX
<br />LNC NaeEa • 212-994-7085 rt. 212-994.7047
<br />S, Tanya—Ste(DhensonPajg.com
<br />INSURERS AFFORDING COVERAGE MAIC 0
<br />New York NY 10177
<br />_
<br />INSURER A;Insurance C Dmpany of State of PA 19429
<br />GL 094.93.89
<br />INSURED
<br />INSURER B: New Hampshire Insurance Company 23841
<br />Greyhound Lines, Inc.
<br />INSURER c: National! Union Fire Ins Co of Pitts - 19445
<br />350 N. St, Paul Street
<br />CLAIMS -MADE IT OCCUR
<br />Dallas, TX 75291
<br />INSURER D:
<br />INSURER E ;
<br />INSURER F:
<br />$5,000,000 —
<br />r nVPRAGF5 r IFRTIFirATF mi im IFP- 1288684543
<br />DFVICIn(1I NI IIIAR170-
<br />T141S 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 />ILTR
<br />TYPE OF INSURANCE
<br />O
<br />D'
<br />—POtJCY EFF
<br />POLICY NUMBER G MIDDIYYYY
<br />POLICY EXP
<br />NIIDD/YYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />GL 094.93.89
<br />12131/2015
<br />12/31/2016
<br />EACH OCCURRENCE
<br />$51000,000
<br />CLAIMS -MADE IT OCCUR
<br />rence)
<br />$5,000,000 —
<br />MEd EXP (Any one person)
<br />S
<br />PERSONAL & ADV INJURY
<br />55°000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />&1,0,000,000
<br />POLICY I X I Jl CT [ X1 LOC
<br />PRODUCTS - COMPIOP AGG
<br />$5,000,000
<br />$
<br />OTHER:
<br />G
<br />A
<br />AUT
<br />X
<br />OMOBILE LIABILITY
<br />ANY AUTO
<br />CA 949248 (AOS)
<br />CA4584447 (MA)
<br />CA45B4448 (VA)
<br />12/3112015
<br />12/31/2015
<br />12/31/2015
<br />12/31/2016
<br />12/3112016
<br />12131/2016
<br />Ea accktent
<br />$5,0o0'00O
<br />INJURY (
<br />BODILY INJURY (Per person)
<br />$
<br />bbl R 1NED ASUHEEiULED
<br />HIREOAUTOS NOTNIOWNED
<br />AUTOS
<br />BODILY INJURY (Per occident)
<br />ERT7D-AN GE ----
<br />Peraccid'ent
<br />$
<br />$
<br />UMBRELLA LIAR I
<br />OCCUR
<br />EACH OCCURRENCE
<br />5
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />E
<br />AGGREGATE
<br />$
<br />QED RETENTION S
<br />O SR5' LSA COMPENSATION
<br />B AND WORKERS
<br />YIN
<br />B ANY PROPRIETORIPARTNERIEXECUTIVE
<br />B OFFICERfMEMBER ExCLUDED7
<br />@ I(Mandalory in NN)
<br />B itYastlesullaeunder
<br />DESCRIPTION OF OPERATIONS below
<br />NlA
<br />WC001705104 (AOS)
<br />WC001705101 (WI)12131/2015
<br />WC 001705095 (FL)
<br />WC 001705104 (OR)
<br />WC001705104 (TX)
<br />WC001705099(CA)
<br />12131/2015
<br />1213112015
<br />12131/2015
<br />1213112015
<br />12131/2015,
<br />12/3112016
<br />12/31/2016
<br />12/3112016
<br />12131/2016
<br />12131/2016
<br />12/31/2016
<br />X PT,gTUTE ERS
<br />E.L. EACH ACCIDENT $5,000,000
<br />_�_ --- T__ ,....._
<br />E.L.,,DISEASE-EA EMPLOYE $5,000,000
<br />E.L. DISEASE - POLICY LIMIT $5,000,000
<br />B
<br />B
<br />R
<br />Workers Compensation
<br />Workers Compensation
<br />Workers Compensation
<br />1705100 (IL,NC,NH,U`T,VT,ill,
<br />WC044216117 (MNj
<br />WC00170510 k MA
<br />213112015
<br />213112015
<br />213112015
<br />12/31/2016
<br />1213112016
<br />12/3112016
<br />E -L. Each Accident 5,000„000
<br />E.L. Disease -EA Emp 51000,000
<br />E.L. Disease -Policy 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101., Addlllonal Rarnarks Schedule, may be attached If more space Is required)
<br />Workers Copperlsation:
<br />Policy #:1705104 (A ,GA) & WC 001705100 (NJ,PA)
<br />Policy Term: 12/31/15 to 12/31/16
<br />Carrier Name: NEW HAMPSHIRE INS CO (NAI''C #:23841)
<br />Limits: E.L. Each Accident / E.L. Disease -Ea Employee / E.L. Disease -Policy Limit, $5,0001000
<br />_ __ ._
<br />See Attached,,. HLIiIJ I ^ r
<br />FtltJil,F 1LI l D,A
<br />City of Santa Ana
<br />c/o Public Warks Agency/SARTC
<br />1000 Santa Ana BIwd,Suite#108
<br />Santa Ana CA 92701 USA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />REPRESENTATIVE
<br />W i 11titf-ZU14 AS::G1KU a,. UIRPURATION. All rights reserved..
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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