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2013-12-05_GENERAL DOCUMENTS - C1981028
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2013-12-05_GENERAL DOCUMENTS - C1981028
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Last modified
8/24/2016 5:37:49 PM
Creation date
12/6/2013 8:21:26 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981028
IBM Index Class Name
General Documents
Doc Date
12/5/2013
Doc Name
Certificate of Insurance (Emailed)
From
Ben Moline
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JLE
SB1
Media Type
D
Archive
No
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'°«vMUrM CERTIFICATE 4F LIABILITY INSURANCE <br />INSURANCE, tn/zot4 <br />DATE {MRV12013Y) <br />10/29/2013 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER (S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER Lockton Companies, LLC Denver <br />8110 E Union Avenue <br />Suite 700 <br />Denver CO 80237 <br />(303) 414 -6000 <br />NA E: <br />FAX <br />A/ No F11; A/C No): <br />E l <br />LIMITS <br />A <br />INSURER A: ACE American Insurance Company <br />22667 <br />INSURED Molson Coors Brewing Company <br />1030130 Coors Energy Company <br />311 10th St., Suite 400 <br />Golden, CO 80401 <br />INSURER B: <br />11/1/2013 <br />INSURER C <br />EACH�OECCURRENCE <br />INSURER D: <br />PREMISES Eaoo�cuErrOerwe <br />XXXXXXX <br />MED EXP (Any one person) <br />5,000 <br />PERSONAL & ADV INJURY <br />COVFRAGFS M( 11 .('( )111 CFRTIFICATF NI IMRFR• 1 AZ0071 ocvrcrnu w luoce. V V V V V V V <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />L <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />WyD <br />POLICY NUMBER <br />P CY F <br />POLICY EXP <br />mwDDrryyyi <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X CDMMERCIALGENER4LLIABILITY <br />CLAIMS -MADE I OCCUR <br />X Vendors <br />N <br />N <br />OGLG25700983 <br />11/1/2013 <br />11 :1/2014 <br />EACH�OECCURRENCE <br />2,000,000 <br />PREMISES Eaoo�cuErrOerwe <br />XXXXXXX <br />MED EXP (Any one person) <br />5,000 <br />PERSONAL & ADV INJURY <br />S 2,000,000 <br />X <br />S 1 00,000 SM <br />GENERAL AGGREGATE <br />S 2,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER <br />PR <br />P I 7 LOC <br />I PRODUCTS • COMPIOP AGG <br />s 2,000,000 <br />S <br />A <br />AUTOMOBILE LIABILITY <br />X ANY AUTO EE <br />ALL ED SCHEDULED <br />AUTOS <br />X HIRED AUTOS AUTOSWNE O <br />N <br />N <br />CALHO8610319 <br />II/l/2013 <br />11/1/2014 <br />E,MaccidDISINGLELIMIT <br />s 2,000,000 <br />BODILY INJURY (Per person) <br />S XXXXXXX <br />BODILY INJURY (Per accident <br />S XXXXXXX <br />PPeOPPER, Y DAMAGE <br />$ XXXXXXX <br />$XXXXXXX <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />NOT APPLICABLE <br />EACH OCCURRENCE <br />S XXXXXXX <br />AGGREGATE <br />$ j(}{j(}(xxx <br />DED I I RETENTION S <br />S <br />AND EMPLOYERSELWBIL�TY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? ❑ <br />fMYyaeendamty in NH) <br />DESCRIPnTIOM p OF U1. <br />NIA <br />HOT APPLICABLE <br />WC g U <br />TORY LIMITS OTH• FIR <br />E.L. EACH ACCIDENT <br />S XXXXXXX <br />E.L. DISEASE -EA EMPLOYEE <br />XXXXXXX <br />E.L. pISEASE- POLICY LIMIT <br />XXXXXXX <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES !(Attach ACORD t01, Additional Remarks Schedule, If more space Is required) <br />RE: Keenesburg Mine, <br />vin r rrrvn r c nv�.�r =n <br />I,.RIV4tLL/i ! I VIV <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />1439971 <br />AUTHORIZED REPRESENTATIVE <br />Colorado Division of Reclamation <br />Mining and Safety <br />1313 Sherman Street, Room #215 <br />Denver CO 80203 <br />roc � � I:►'r <br />ACORD 25 (2010/05) @10842010ACORDCORPOICATION. All rights reserved <br />The ACORD name and logo are registered marks of ACORD <br />
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