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ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDrYYYY)
<br />1
<br />`�
<br />12/19/2018
<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: It the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Tanya D. Stephenson
<br />Arthur J. Gallagher Risk Management Services, Inc.
<br />_
<br />F
<br />PHOfA'C FAFxtk
<br />250 Park Avenue
<br />212-994-7085 u • 212-994.7047
<br />E -MRL
<br />ADDRESS: Tan a Ste henson a' .com
<br />3rd Floor
<br />New York NY 10177
<br />_ INSURER(S)AFFORDING COVEITAOE _ NA1C# _
<br />INSURER A: New Hampshire Insurance Company 23841
<br />I i �.�EMIS1;5 (F.�.acsull@O�e.)_-_
<br />INSURED
<br />INSURER a :-National Union Fire Insurance Com�aqyof Pittsburg 19445_
<br />Greyhound tines. Inc.
<br />-.--- ----------------------___---
<br />350 N. St. Paul Street
<br />INsuRER C :American Home Assurance Compap 19380
<br />- — --
<br />Dallas, TX 75201
<br />INSURER E_-- -- -- ------------ - - ---
<br />- i —
<br />$5.000,000
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER:1318672901 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY
<br />THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />A DL B
<br />ILTH
<br />POLICY EFF POLICY EXP
<br />TYPE OF INSURANCE
<br />LTR i POLICYNUMBFA
<br />MMDDIYYYY MMDDIYYYY ! . LIMITS
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />GL 3829887
<br />12!31/2018 12/31/2019 EACH OCCURRENCE
<br />5,000,000
<br />CLAIMS -MADE (X OCCUR i
<br />l _L$
<br />I-bA1afAGETb REtTtED
<br />_
<br />$ 5,000,000
<br />-1
<br />_ L 1- �
<br />i
<br />I i �.�EMIS1;5 (F.�.acsull@O�e.)_-_
<br />-
<br />X Contractual _._ __. _ .
<br />- -1 -----'- -. _ ..
<br />I MED EXP (Any one person)__
<br />$
<br />_
<br />X Uab Ind. —
<br />PERSONAL 8 ADV INJURY
<br />$5.000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER: I
<br />l i GENERAL AGGREGATE
<br />$10,000,000
<br />�� 1 PRO- i I I
<br />POLICY ', X i JECT X LOC i
<br />t --
<br />t PRODUCTS • COMPIOP AGG
<br />- ----- ---
<br />$_5,000,000
<br />OTHER:
<br />I
<br />I $
<br />B
<br />AUTOMOBILE LIABILITY
<br />CA 1921794 (AOS)
<br />12/31/2018i 12/31/2019 COMBINED SINGLE LIMIT g S,000,ODO
<br />SEIlac4den)
<br />B
<br />B
<br />X :ANY AUTO
<br />i
<br />CA1921795(MA)
<br />CAI 921796 (VA)
<br />12/31/2018 12/31/2019
<br />12/31/2018 I 12/37/2019 BODILY INJURY (Par person) S - -- —
<br />• OWNED (-1 SCHEDULED
<br />I i BODILY INJURY (Por accidanII $
<br />AUTOS ONLY I AUTOS
<br />HIRED NON -OWNED
<br />I j F+ROPERTY0AMA0E -
<br />$
<br />AUTOS ONLY AUTOS ONLY
<br />i
<br />I (1PeraccldOnIL____--__-
<br />j UMBRELLA UA13OCCUR
<br />HCLAIMS-MADE
<br />EACH OCCURRENCE
<br />EXCESS LIAR -
<br />I
<br />I I AGGREGATE $
<br />OED RETENTION $
<br />$
<br />A WORKERS COMPENSATION
<br />WC 014649556 (AOS))
<br />12/31/2018 12/31/2019 'X PER oTH
<br />T�TUTe=�
<br />A AND EMPLOYERS' LIABILITY YIN
<br />j
<br />WC 014649555 ^MA)
<br />112/3112018 I 12/31/2019 —
<br />A ANYPROPRIETOR/PARTNER/EXECUTIVE ❑
<br />A OFFICERRAEMBEREXCLUDED7
<br />NIA i
<br />WC 014649552 (FL)
<br />WC 014649557
<br />12/3112018 12/31/2019 E.L. EACH ACCIDENT g 5,000,000
<br />12/31/2018 ! --
<br />C (Mandatory In NH)
<br />(MN)
<br />WC 014849553 (CA)
<br />12/31/2019
<br />12/3112018 12/3112019 E.L. DISEASE_ EA EMPLOYEE $ 5,000,000
<br />' ------ '_-- --- _" - --
<br />urs, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />L
<br />E.L. DISEASE • POLICY LIMIT $ 5,000,000
<br />REVIEWED BY:
<br />I I
<br />EUNICE HEREDIA (PG I OF
<br />I
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached II more space Is required)
<br />Workers Compensation:
<br />Policy #: WC 014649554(AZ,IL,KY,NC,NH,NJ,PA,UT,VA,VT)
<br />Policy Term: 12/31/18 to 12/31/19
<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
<br />Ana CA,
<br />City of Santa Ana, Its agents, officers, employees and volunteers are Included as Additional
<br />Insured as respects General Liability(blanket
<br />See Attached...
<br />CFRTIFICATF HOLDER rAhICIPI I ATInFJ
<br />®1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />2 of 3 7518
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />c/o Public Works Agency/SARTC
<br />1000 Santa Ana Blvd,Suite#108
<br />Santa Ana CA 92701
<br />USA
<br />AUTHORIZED REPRESENTATIVE
<br />®1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />2 of 3 7518
<br />
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