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2014-10-16_GENERAL DOCUMENTS - C1981025
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2014-10-16_GENERAL DOCUMENTS - C1981025
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Last modified
8/24/2016 5:48:57 PM
Creation date
10/20/2014 9:42:36 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981025
IBM Index Class Name
General Documents
Doc Date
10/16/2014
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
BFB
DIH
Media Type
D
Archive
No
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/EMC Insurance Companies <br />PAGE NO: 2 <br />EMPLOYERS MUTUAL CASUALTY COMPANY POLICY NUMBER: 3D6- 49- 04 - - -15 <br />S AND B HOLDINGS, LLC EFF DATE: 09/01/14 EXP DATE: 09/01/15 <br />G E N E R A L L I A B I L I T Y P 0 L I C Y <br />D E C L A R A T I O N S <br />------------------------ <br />ENDORSEMENT SCHEDULE <br />DATE OF ISSUE: 08/20/14 <br />FORM: IL7131A (ED. 04 -01) 005 SB 3D64904 1501 <br />EDITION <br />FORM <br />------------------------------------------------------------------------------ <br />DATE <br />DESCRIPTION /ADDITIONAL INFORMATION PREMIUM <br />*IL7131A <br />04 -01 <br />COMM'L POLICY ENDORSEMENT SCHEDULE <br />IL7338 <br />05 -12 <br />EARLIER NOTICE CANC PROV BY US -DESIG <br />NAME: STATE OF COLORADO <br />DIVISION OF RECLAMATION MINING AND <br />SAFETY <br />ADDRESS: 1313 SHERMAN ST., RM 215 <br />NUMBER. OF DAYS ADVANCE NOTICE: 30 <br />IL7602 <br />01 -99 <br />COLORADO COMPANY ELIMINATION <br />*IL8021 <br />04 -88 <br />ASBESTOS NOTICE <br />*IL8383.5 <br />01 -08 <br />DISCL PURSUANT TERRSM RISK INS. ACT <br />PREMIUM THROUGH 12/31/14 $ 2 <br />PREMIUM BEYOND 12/31/14 $ 5 <br />IL8384A <br />01 -08 <br />TERRORISM NOTICE <br />*IL8576 <br />09 -09 <br />MEDICARE IMPT NOTICE TO POLICYHOLDER <br />DATE OF ISSUE: 08/20/14 <br />FORM: IL7131A (ED. 04 -01) 005 SB 3D64904 1501 <br />
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