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AC"RV CERTIFICATE OF LIABILITY INSURANCE
<br />`,,.,i'
<br />DATE (MMIDDIYYVV)
<br />12/19/20'16
<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 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 doesnot confer ri hts to the certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />Arthur J. Gallagher Risk Management Services, Inc.
<br />250 Park Avenue
<br />3rd Floor
<br />New York NY 10177
<br />COME:NTACT
<br />NA TDI1 a D, Ste henson
<br />- _ -- __ _
<br />a��NN Sell: 21 _ _-_ -(/6Q1. 212.994.7047 —
<br />EMAIL
<br />_�RFG�,Tan)a_StephensonGSjg.Com
<br />INSURER(S) AFFORDING COVERAGE NAIC#
<br />INSURER A; New Harn shire Insurance Corn any _ 23641
<br />INSURED
<br />_
<br />INSURER B.Natlonal Union Fire Insurance ComEa _ __]19446
<br />Greyhound Lines, Inc.
<br />350 N. St. Paul Street
<br />Dallas, TX 75201
<br />INSURER C:American Home Assurance Company _
<br />INSURER D: ----
<br />------- - -- -----
<br />$5,000,000
<br />INSURER E.
<br />INSURER F:
<br />—_
<br />$5,000,000_
<br />COVERAGES CERTIFICATE NUMBER: 1303225471 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 THE POLICIES DESCRIBED HEREIN IS SUBJECT "r0 ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />51� R�--
<br />LTR
<br />---�
<br />TYPE OFINSURANCE
<br />"Of
<br />SUBR
<br />VO
<br />--
<br />POLICY NUMBER
<br />POLICY EFF`
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDIYVYY
<br />-�--
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE LE OCCUR
<br />GL 3629887 112/31/2016
<br />12131/2017
<br />EACH OCCURRENCE
<br />$5,000,000
<br />_—
<br />_TAMAGETO�TD_.._.
<br />PREMISES Ea owurtence
<br />—_
<br />$5,000,000_
<br />EXP (Anyone persen
<br />$
<br />_MED
<br />_PERSONAL & ADV INJURY
<br />$5,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$10,000,000
<br />GENT
<br />POLICY rtRL7 F LOC
<br />_
<br />PRODUCTS-C:OMPIOPAGG
<br />—
<br />$5,000,000
<br />$ -
<br />OTHER:
<br />B
<br />B
<br />B
<br />AUTOMOBILE:
<br />LIABILITY
<br />CA 1921794 (AOS)
<br />CA1921795(MA)
<br />CA19Z1796 (VA)
<br />1213112016
<br />1213'1!2016
<br />1213112016
<br />1213112017
<br />12/3112017
<br />12/3112017
<br />COMEa HINEDOS -
<br />$6,090,000
<br />_ -----
<br />PODILY INJURY(Par person)
<br />_.,
<br />$
<br />BODILYINJURY tPernccchnhAUTOSONLY
<br />JXANYAUTIINUEETMIT
<br />NLD SCHEDULED
<br />_AUfOs FARED NOTNOD":�y AUTOS ONLY - All ON L
<br />(Par eccidenlL
<br />-_
<br />$
<br />_
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAR
<br />CLAIMS_MAOE
<br />DED RETENTION $
<br />_ _
<br />$
<br />A
<br />C
<br />A
<br />A
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY VIN
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE N
<br />OFFICERIMEMOER EXCLI/DE09
<br />(Mandatory in NH)
<br />If yes, desadbe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WC 014649656 AOS,OR,TX,GA)
<br />WC 014649553 CA)
<br />WC 01 4 64 95 5 5 WI, MA)
<br />WC 014649562 FL)
<br />WC 014649557 MN)
<br />12/3112016
<br />12/3'112016
<br />12/3112016
<br />12/3112016
<br />12/3112016
<br />_
<br />12131/2017
<br />12!31/2017
<br />12!3112017
<br />12131/2017
<br />12/3112017
<br />X STATUTE OR�_—
<br />—'-
<br />. -
<br />E.L. EACH ACCIDENT
<br />----
<br />$5,000,000
<br />—
<br />G.L. DISEASE EA EMPLOYEE
<br />---
<br />- - - ----
<br />$6,000,000
<br />E.L. DISEASEPOLICYLIMIT
<br />—--
<br />$6,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Workers Compensation:
<br />Policy #: WC 014649554 (AZ,IL,NC,NH,NJ, PA,1_l
<br />Policy Term: 12/31/16 to 12/31117
<br />Carrier Name: NEW HAMPSHIRE INS CO (NAIC #:23841)
<br />Limps: E.L. Each Accident / E.L. Disease -Ea Employee / E.L. Disease -Policy Limit - $5,000,000
<br />See Attached... �/`i�iLLJf •„/ ��° C/ "r �hda Cy/ �9r'"`G",. </4j'.
<br />CERTIFICATE HOLDER CANCELLATION
<br />Q 1968.2015 ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<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 />c/o Public Works Agency/SARI'C
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />1000 Santa Aria Blvd,Sulte#108
<br />Santa Aria CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />HSA
<br />Q 1968.2015 ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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