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Y CERTIFICATE NUMBER
Ai .. a CHI-001241118-02
PRODUCER
MARSH USA INC..
BANK ONE CENTER
111 MONUMENT CIRCLE
SUITE 4300
INDIANAPOLIS, IN 46204-2492
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY
Attn: Linda Bottoms 317-261-9321
87962---
A LIBERTY SURPLUS INSURANCE CORP.
INSURED
/
COMPANY
AEARO CORPORATION
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B N/A
5457 WEST 79TH STREET
INDIANAPOLIS, IN 46268
1 /
COMPANY
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C LIBERTY MUTUAL INSURANCE CO
AO. f}471y fll�9
COMPANY
D N/A
L
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 REQUIREMENT, 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
D:;,E (L:N17DD,'W)
POLICY EXPIRATION
DATE (tA=D, FO
LIMITS
A
GENERAL
LIABILITY CONTRACTU
EGL-BO-078981-042
09/30/05
09/30/06
GENERAL AGGREGATE
$ 2,000,000
X
PRODUCTS - COMP/OP AGG
$ 2,000,000
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE rx I OCCUR
i M
PERSONAL B ADV INJURY
$ 1,000,000
EACH OCCURRENCE
$ 1,000,000
OWNER'S & CONTRACTOR'S PROT
X
FIRE DAMAGE (Any one fire)
$ 50,000
X
SIR 20.000 PREMISES
MED EXP (Any one rson
$ NIL
C
AUTOMOBILE
LIABILITY
ANY AUTO
AS2-641-005060-055
09/30/05
09/30/06
COMBINED SINGLE LIMIT
$ 1,000,000
X
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
$
HIRED AUTOS
NON -OWNED AUTOS
OMP DED: 2,500
X
PROPERTY DAMAGE
$
X
PrIOLL DED: 2,500
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO
EACHACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
UMBRELLA FORM
$
OTHER THAN UMBRELLA FORM
C
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
WA2-64D-O05O60-07.5(DOS)
$250,000 DED (AOS ONLY)
O9/3C/05
09/30/05
00/30/06
09/30/06
X A U- H
TURY LIMITS ER
'4s"a^ +�w:}c
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EL EACH ACCIDENT
$ 1,000,000
C
THE PROPRIETOR/ X INC L
PARTNERSIEXECUTIVE
WC2-641-005060-065 (OR, W)
09/30/05
09/30/06
EL DISEASE -POLICY LIMIT
$ 1,000,000
EL DISEASE -EACH EMPLOYEE
$ 1,000,000
OFFICERS ARE: EXCL
HER
DESCRIPTION OF OPERATIONSAACATIONSNEHICLES/SPECIAL ITEMS
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
CITY OF FT.
CI TN: F FT. C COLLINSLLIN
THE INSURER AFFORDING COVERAGE WALL ENDEAVOR TO MAIL . An DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
300 LAPORTE AVENUE
FT. 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: Linda Bottoms 46/4 l�I'1ogol
OF: 3