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CER I �E,r
TIFICATE NUMBER
HOU-000440894-04
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA INC.
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
1000 LOUISIANA
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
SUITE 4000
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
HOUSTON, TX 77002
COMPANIES AFFORDING COVERAGE
COMPANY
IRS
A ZURICH AMERICAN INS.CO
INSURED
COMPANY
Industrial Repair Service, Inc.
1113 Camina Entrada
B AMERICAN GUAR & LIAB
Farmington, NM 87401
COMPANY
C AMERICAN ZURICH INSURANCE CO.
COMPANY
D
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENwu
T, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
A
GENERALLIASIUTY
GLO 9298347-04
01/15/04
01/15/0$
GENERAL AGGREGATE
$ 2,000,000
X
PRODUCTS - COMP/OP AGG
$ 1,000,000
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx_] OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
EACH OCCURRENCE
$ 1,000,000
OWNER'S & CONTRACTOR'S PROT
FIRE DAMAGE (Any one fire)
$ 1,000,000
MED EXP (Any one n
$ 5,000
B
B
AUTOMOBILE
LIABILITY
ANY AUTO
BAP 9298344-04
TAP 9298346-04
01/15/04
01/15/04
01/15/05
01/15/05
COMBINED SINGLE LIMIT
$ 1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
X
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
MMEMEW
ANY AUTO
EACH ACCIDENT
j
$
AGGREGATE
$
-
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
$
C
WORKERS COMPENSATION AND
EMPLOYERS'LIABWTY
WC9298348-04
01/15/04
01/15l0$
X TORY LIMITS ER
tI 1,P. rlylfil FliT�;.,.
EL EACH ACCIDENT
$ 1,000,000
THE PROPRIETOR/ X INCL
PARTNERS/EXECUTIVEOFFICERS
EL DISEASEPOLICY LIMIT
$ 1,000,000
EL DISEASE -EACH EMPLOYEE
$ 1.000.000
ARE: EXCL
VIMLK
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
CITY OF FORT COLLINS
PO BOX 580
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 10 WRITTEN DAYS NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
256 W. MELTON AVE.
FORT COLLINS, CO 80521
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES. OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC. _
BY: Duncan T. Plaskett
� VALID AS OF b 01l14l04 3�
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