HomeMy WebLinkAbout20031392.tiff MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER
J CERTIFICATE rWM C OF INSURANCE R N17\L C HOU-000334330-02
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
401 So. Boston Ave.,Suite 800 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
Tulsa,OK 74103-4016 AFFORDED BY THE POLICIES DESCRIBED HEREIN.
Attn. Marilyn Lowe (918)586-7900 COMPANIES AFFORDING COVERAGE
COMPANY
100652--- A LIBERTY MUTUAL FIRE INS CO
INSURED COMPANY
Flint Energy Services, Inc. B LIBERTY MUTUAL INSURANCE CO
One Memorial Place
7633 E.63rd Place,Suite 500 COMPANY
Tulsa,OK 74133 C
COMPANY
D
COVERAGES-This certificate supersedes and replaces any:previously issued certificate for the policy period notedbelow. 0
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 TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE IMM/DD/YY) DATE IMM/DD/YY)
A GENERAL UABIUTY KE1-B71-071834-032 11/01/02 11/01/03
GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY
PRODUCTS-COMP/OP AGG $ 2,000,000
. I CLAIMS MADE X OCCUR PERSONAL 8 ADV INJURY $ 2,000,000
X OWNERS&CONTRACTOR'S PROT EACH OCCURRENCE $ 1.000,000
FIRE DAMAGE(Any one fire) $ 500,000
MED EXP(Any one person) $ 10,000
B AUTOMOBILE LIABIUTY ASt-B71-071834-022 11/01/02 11/01/03
COMBINED SINGLE LIMIT $ 2,000,000
X ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per Person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY 4 -
EACHACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
A WORKERS COMPENSATION AND WA1-B7D-071834-073 06/01/03 06/01/04 X I ORSTATUS I OR
EMPLOYERS'LIABILITY
TORY LIMITS ER
EL EACH ACCIDENT $ 1,000,000
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ 1,000,000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
If required by written contract,the certificate holder is an"additional insured"but only with respect to the insureds operation of the Named Insured,except
the"additional insured"does not apply to Workers Compensation policies.A Waiver of Subrogation also applies in favor of the certificate holder.
CERTIFICATE HOLDER = i'. CANCELLATION ._ --
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 3Q DAYS WRITTEN NOTICE TO THE
WELD COUNTY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ALLEN MILLER
P.O.BOX 758 LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE
GREELEY,CO 80632 ISSUER OF THIS CERTIFICATE.
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MARSH USA INC.
4 G7171,j77el4/7c i i0.0S BY: Marilyn Lowe Y/la1Alyiu deecua-
/ MM1(3/02} VALID AS OF: 05/22/03
C6 -cs
2003-1392
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