My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2016-08-29_PERMIT FILE - C1981035A (45)
DRMS
>
Day Forward
>
Permit File
>
Coal
>
C1981035
>
2016-08-29_PERMIT FILE - C1981035A (45)
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/5/2023 9:48:18 AM
Creation date
10/19/2016 10:15:44 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981035A
IBM Index Class Name
PERMIT FILE
Doc Date
8/29/2016
Doc Name
Insurance: Personal Injury & Property Damage
Section_Exhibit Name
KI Appendix 14
Media Type
D
Archive
Yes
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
28
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />NOTIFICATION TO OTHERS OF CANCELLATION ENDORSEMENT <br />This endorsement is used to add the following to Part Six of the policy. <br />PART SIX <br />CONDITIONS <br />WC 99 06 33 <br />A. If we cancel this policy by written notice to you for any reason other than nonpayment of premium, we will mail <br />or deliver a copy of such written notice of cancellation to the name and address corresponding to each <br />person or organization shown in the Schedule below. Notification to such person or organization will be <br />provided at least 10 days prior to the effective date of the cancellation, as advised in our notice to you, or the <br />longer number of days notice if indicated in the Schedule below. <br />B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of <br />such written notice of cancellation to the name and address corresponding to each person or organization <br />shown in the Schedule below at least 10 days prior to the effective date of such cancellation. <br />C. If notice as described in Paragraphs A or B. of this endorsement is mailed, proof of mailing will be sufficient <br />proof of such notice. <br />SCHEDULE <br />Name and Address of Other Person(s) / Organization(s): <br />Number of <br />Days Notice: <br />OFFICE OF SURFACE MINING RECLAMATION <br />30 <br />AND ENFORCEMENT, WESTERN REGION <br />1999 BROADWAY, SUITE 3320 <br />DENVER, CO 80202— 3050 <br />All other terms and conditions of this policy remain unchanged. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective <br />Insured <br />Insurance Company <br />Policy No. <br />Endorsement No. <br />Premium $ <br />WC 99 06 33 <br />(Ed. 05-10) Includes copyrighted material of National Council on Compensation Insurance, Inc. with its permission. Pagel of 1 <br />
The URL can be used to link to this page
Your browser does not support the video tag.