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Ac'b,m. CERTIFICATE OLI LIABILITY INSURANCE
<br />DATE (MM/DDYYYY)
<br />12/29/2014
<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(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 lieu of such endorsement(s).
<br />PRODUCER
<br />Arthur J. Gallagher Risk Management Services, Inc.
<br />250 Park Avenue
<br />3rd Floor
<br />CONTACT
<br />NAME: Tana D. Stephenson
<br />PHONE FAx
<br />212-994-7085 tNa). 212-994 7047_
<br />v
<br />E-MAIL . Tanya_Stephenson@ajg.com
<br />_
<br />INSURERS) AFFORDING COVERAGE NAIC # Y
<br />New York NY 10177
<br />INSURER A:Insurance Company of State of PA 19429
<br />INSURED
<br />INSURER B: New Hampshire Insurance Company 23841
<br />INSURER C: National Union Fire Ins Co Pittsbur 19445
<br />Greyhound Lines, Inc.
<br />350 N. St. Paul St.
<br />Dallas, TX 75201
<br />INSURER D
<br />INSURER E
<br />INSURER F ;
<br />COVERAGES CERTIFICATE NUMBER: 1239051647 REVISION NUMRFR°
<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 />INSIRLTR
<br />TYPE OF INSURANCE
<br />AI SD
<br />WVD
<br />POLICY NUMBER
<br />MMLDDY/YYYY
<br />MM/DDIYYYY)
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />GL 0949389
<br />12/31/2014
<br />12/31/2015
<br />EACH OCCURRENCE
<br />$5,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$5,000,000
<br />MED EXP (Any one person)
<br />$
<br />PERSONAL & ADV INJURY
<br />$5,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRO -
<br />POLICY PRO LOC
<br />GENERAL AGGREGATE
<br />$10,000,000
<br />_
<br />PRODUCTS - COMP/OP AGG
<br />$5,000,000
<br />$
<br />OTHER:
<br />C
<br />A`
<br />C
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALL AUTOS OWNED SCHEDULED
<br />AUTOS
<br />Y
<br />CA 949248 (AOS)
<br />CA4882242 (VA)
<br />CA4584447 (MA)
<br />12/31/2014
<br />12/31/2014
<br />12/31/2014
<br />12/31/2015
<br />12131/2015
<br />12/31/2015
<br />Ea accident) SINGLE LIMIT
<br />$5,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />$
<br />B
<br />B
<br />B
<br />A
<br />B
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PRO PRIETO R/PARTN E R/ EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑N
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />W0001705104 (AOS)
<br />WC001705101(WI)
<br />WC 001705095 (FL)
<br />WC 001705104 (OR)
<br />WC001705104 (TX)
<br />WC 001705099 (CA)
<br />12/31/2014
<br />12/31/2014
<br />12/31/2014
<br />12/31/2014
<br />12/31/2014
<br />12/31/2014
<br />12/31/2015
<br />12/31/2015
<br />12/31/2015
<br />12/31/2015
<br />12/31/2015
<br />12/31/2015
<br />X STATUTE OERH
<br />E.L. EACH ACCIDENT
<br />$5,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$5,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$5,000,000
<br />B
<br />B
<br />B
<br />Workers Compensation
<br />Workers Compensation
<br />WC44216118(MN)
<br />WC001178530 (MA)
<br />1705100 (IL,NC,NH,UT,VT,
<br />12/31/2014
<br />12/31/2014
<br />12/31/2014
<br />12/31/2015
<br />12/31/2015
<br />12/31/2015
<br />E.L. Each Accident 5,000,000
<br />E.L. Disease -EA Emp 5,000,000
<br />E.L. Disease -Policy 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Workers Compensation:
<br />Policy #: 1705104 (AZ,GA) & WC 001705100 (NJ,PA) GREYHOUND A-2006-028 REVIEWED BY:
<br />Policy Term: 12/31/14 to 12/31/15 EDNICE HEREDIA (PG. 1 of 3)
<br />Carrier Name: NEW HAMPSHIRE INS CO (NAIC #:23841)
<br />Limits: E.L. Each Accident / E.L. Disease -Ea Employee / E.L. Disease -Policy Limit - $5,000,000
<br />Re: leased location - The Depot at Santa Ana; 1000 East Santa Ana Boulevard, Santa Ana CA. Landlord, Its agents,
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Anac/o Public Works Agency/SARTC
<br />1000 Santa Ana Blvd
<br />Suite#108
<br />Santa Ana CA 92701 USA
<br />IMMUNWONEVAIM11111410 W"
<br />FA4101*1 14 ITTA 0 11141;alkl I I iR I i I MWAJ 11111 =011
<br />AUTHORIZED REPRESENTATIVE
<br />
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