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HomeMy WebLinkAboutC16-433 Hertz CorporationDocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B     C16-433 DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2,000,000 01/01/2017 HDO G27403219 Manashi Mukherjee SCF C48596368 (WI) NYC-008592199-02 2,000,000 WLR C48596289 (AZ, CA, MA) X 43575 of Marsh USA Inc. Attn: Hertz.certrequest@marsh.com Fax 212-948-0979 N X 2,000,000 01/01/2016 8 01/01/2017Self-Insured up to $2,000,000 B 2,000,000 2,000,000 20702 Indemnity Ins Co Of North America 2,000,000 X X 11/16/2016 Dravin 01/01/2016 01/01/2016 EAGLE COUNTY, COLORADO, AND EAGLE COUNTY AIR TERMINAL CORPORATION ITS AGENTS, OFFICERS, EMPLOYEES SERVANTS, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH REGARDS TO GENERAL AND AUTO LIABILITY FOR ALL WORK CONTRACTUALLY OBLIGATED PURSUANT TO THE X 01/01/2016 500 BROADWAY EAGLE, CO 81631-0850 EAGLE COUNTY GOVERNMENT AGREEMENT. A C ACE Fire Underwriters Insurance Company 100595-2M-GAW-16-17 10,000 01/01/2017 2,000,000 A All other States 22667 1,000,000 2,000,000 WLR C48596320 (AOS) 445 SOUTH STREET MARSH USA, INC. MORRISTOWN, NJ 07962-1966 (SEE ATTACHED LISTING) HERTZ GLOBAL HOLDINGS, INC. ESTERO, FL 33928 8501 WILLIAMS ROAD 01/01/2016 P.O. BOX 850 01/01/2017 '*** See Attached ***' 01/01/2017 ACE American Insurance Company DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: HERTZ GLOBAL HOLDINGS, INC. IS SELF INSURED IN THE FOLLOWING STATES - AL, AZ, CA, CT, FL, GA, ID, IL, KY, LA, MA, MD, MO, NC, NJ, NV, OK, PA, SC, TX, VA, ADDITIONAL NAMED INSUREDS: FIREFLY RENT A CAR LLC 22 POLICY #ISA H08866703 - HERTZ RAC - MINIMUM FINANCIAL RESPONSIBILITY (MFR) LIMIT PER STATE - CO, MI, MS, NH, NM, OR, RI, SD Morristown ACE AMERICAN INSURANCE CO. 01/01/2016 - 01/01/2017 AUTOMOBILE LIABILITY CONTINUED: Certificate of Liability Insurance 100595 POLICY #ISA H09051053 - 10/01/2016 - 10/01/2017 - MINIMUM FINANCIAL RESPONSIBILITY (MFR) LIMIT FOR NEW YORK ONLY VT, WA, WI HERTZ VEHICLES, LLC HERTZ LOCAL EDITION (HLE) MARSH USA, INC. (SEE ATTACHED LISTING) HERTZ GLOBAL HOLDINGS, INC. ESTERO, FL 33928 8501 WILLIAMS ROAD THE HERTZ CORPORATION 25 DocuSign Envelope ID: 321B776C-F9C8-4C69-BBC6-D5A285DC209B