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COI Expires 04/15/2015P526W2aW2 CERTIFICATE OF LIABILITY INSURANCE I DATE 09/02/2014 (MWDONYYY' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-727-797-4190 CONTACT NAYS: Staci Moles Arthur J. Gallagher Risk Management Services, Inc. PHONE 727-796-6267 'FAX 727-791-1613 LAIC N9 Ext): t".Ilo) 4904 Eisenhower Blvd., Ste 250 Tampa, FL 33634 Ron Walters INSURED _ Evergreen Trails, Inc. dba Horizon Coach Lines Horizon Coach Lines Paymaster LLC; FSCS Corporation; TMS West Coast, Inc.; Horizon Coach Lines HC Inc. 14901 Quorum Drive, Suite 715 Dallas, TX 75254 E-MAIL ADDRESS: staci_moleoftig.com INSURER(S) AFFORDING COVERAGE NAM: II INSURER A: OCCIDENTAL FIRE & CAS CO OF NC 23248 INSURERB: LEXINGTON INS CO 119437 INSURERC: CYPRESS INS CO 10855 INSURER D: BERKSHIRE HATHAWAY HOMESTATE INS CO I20044 INSURERE: UNDERWRITERS AT LLOYDS LONDON 115792 ^OnT1O1^ATC ►111a1000. A111CZ97 RFVISIr1N NIIYRFR- v THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - - - - ADDL SUSRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDOTYYY MMMDNYYY LIMITS A GENERAL LIABILITY CLOO189301 04/15/1 04/15/151 EACHOCCURRENCE t 5,000,000 X j DAMAGE TO RENTED PREMISES (Ea � $ 100, 000 II COMMERCIAL GENERAL LIABILITY 1 CLAIMS -MADE I X i OCCUR occurrence) MED EXP (Any one person) i $ 5,000 ` PERSONAL d ADV INJURY I $ 5,000,000 5,000,000 GENERAL AGGREGATE I = PRODUCTS - COMPIOP AGG j = 5, 000, 000 GENT AGGREGATE LIMIT APPLIES PER: I X POLICY 1 PRO- I LOC ( s A AUTOMOBILE LIABILITY CA00042168 1 1 LEa accident) INGLE LIMOIND B I i 5,000,000 X ANY AUTO I BODILY INJURY (Per person) i $ AUTOWNED i SCHEDULED BODILY INJURY (Per accident) i $ AUTOS 1 NON -OWNED PROPERTY DAMAGE _ HIRED AUTOS AUTOS (Per accident) I S B X UMBRELLA UAB X OCCUR 000992222 04/15/1 04/15/15� EACH OCCURRENCE $5,000,000 1 EXCESS LIAR I CLAIMS -MADE AGGREGATE $ 5,000,000 DED I I RETENTIONS $ C WORKERS COMPENSATION 3300062321-141 08/31/1 08/31/15 X TQRYLIMITSI E D AND EMPLOYERS' LLABILITY ANY PROPRIETORRARTNER/EXECUTIVE YIN FLWO01237 08/31/1 08/31/15I E.L. EACH ACCIDENT $ 1,000,000 OFHCERIMEMBER EXCLUDED? (Mandatory In NH) N/A j E.L. DISEASE - EA EMPLOYE $ 1,000,000 It yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT = 1,000,000 E Auto Physical Damage PAM003698 04/15/1 04/15/15JAny One Occurrence 1,000,000 Any One Vehicle 500,000 Deductible 10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) Certificate holder is included as an additional insured on the General Liability and Automobile policies as required by written contract per forms CG2010 04 13 and AA 14 08 09 08. Waiver of Subrogation in favor of Certificate Holder as respects to Workers* Compensation policy, pursuant to and subject to the policy's terms, def ions, conditions and exclusions as required by written contract. PPRO AHEM /►�,,� DA ;&M& WAN GCK I IFIGA I C nVLUCK ./ ^► *) iNA03 30SN a,nrea,uu l nvn - - 1 i OW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of 1 ��� ��11 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. County Commissioners 1100 Simonton Street ^O b10ZAUTHORIZED REPRESENTATIVE �J Key West, FL 33040� e� �� �� �J�' USA _ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD vimalaclear 41319387 v rn W