Laserfiche WebLink
NEELOI DSA <br /> R <br /> CEIRTIRCATE OF LIABILITYINSURANCE <br /> THIS CERTIFICATE IS ISSUED A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE <br /> CERTIFICATE COVERAGE <br /> BY THE POLICIES <br /> BEL THIS CERTIFICATE F INSURANCE DOE NOT CONSTITUTE A � TRACT BETWEEN THE ISSUING IIURER($)t AUTHORIZED <br /> EARE E� TATIfE R PRODUCER, AND THE <br /> H DER. <br /> M1 PORTAN T. If the Certificate holder t an A D DITI D DIAL IN S U RED, the PD IS or lic Oe iw SURE D an dor d. <br /> If 1.1 ER �1 �111�ED subject � � must have ADDITIONAL I R <br /> f c rtificato GA17 does r to the terms and conditions 0t the policy, certain policies may require an endorsement. A statement on <br /> t confer rights to the cerfificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Daphne Sanders , CI SR, RI , U <br /> Van Meter Insurance rout M�� E - FAX <br /> Houchens Insurance Group WC. No, Ext): (270) 8 = 91 4414 (AC, Not-(2 70) E8 5-334 <br /> 009 Frederica Street E- IL . dsa n d kh l C <br /> Owensboro, KY 42301 <br /> I <br /> INSURE AFFORUNG COVERAGE KAOC 0 <br /> INSURER A - Im1 erium Insurance Comp?ny 35408 <br /> INSURED INSURER 8 . Zurich American Insurance Co m pay 116535 <br /> New Elk Opal Company, LLC INSURER <br /> 12250 Highway 12 D ; <br /> WiD 10n, CO811() 1 INSURER <br /> INSURER E <br /> INSURER F : <br /> COVERAGES NUMBER:CERTIFICATE REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ME D AeOVE FOR THE PCLI Y PERIOD <br /> INDICATED NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCJMENT W TH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED R MAY PERTAIN, THE INSURANCE F F RDE0 BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS* <br /> EXCLUSIONS AND COIFI)ITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDu FD BY PAID CLAIMS <br /> 1N R I <br /> TYPE INSURANCE ADDL SUO I DLJ Y I� LADYEXP POU Y NUMOCYYi UMIT'S <br /> A I X COMMERCIAL GENERAL LIABUTY EACH OCCURRENCE S 110001006 <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,00 <br /> 1 ;110- L 00 4 - 1 <br /> S <br /> PERSONAL & ADV INJURY � 5000,000 <br /> EtTL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 060,000 <br /> POLICY % Lod PRODUCTS - OMR I� AGG 1 00,000 <br /> IsA OTHER <br /> ��IQEDI LE LIMIT UAUIU 1 10 00 A 0 0 <br /> AW AUTOIVIN -1IC- A-O0O0 7A-00 4124=21 412412022 BOD+LY INJUR P on S <br /> WrvED SCHEDULED <br /> BODILY' INJURY�� Per <br /> ALTOS ONLY AUTOS JU a= S <br /> NJV PROPERTY DAMAGE <br /> umaRELLA UAB X OCCUR 5,0000000 <br /> EACH OC�J F�R E t�lCE � <br /> EXCESS UA B CLAIMS-MADE M N G-111 - -0 000 08 -01 412412021 412412022 R T 10001000 <br /> DED RETENTION S <br /> ANY PROP IETOR PARTNER�ECUTWE � � D 0714 r00 81112021 811/2022 E L EACH ACCIDENT Is 11000p)o <br /> FP' E F? 1EMBER EXCLUDED? N / A <br /> (Mandatory in NH) '� ,0001000 <br /> E L DISEASE - EA EMPLOYEE S <br /> If s descnbe under <br /> O RIRTION OF 01PERATIO below E L DI EA - POLICY LIMIT 5 � <br /> 0001000 <br /> DE SCRI PTION OF OPE RATI ONS I LOCAMNS I VSH I LE S JA ORD 101 k Add Itl onal Rennarks Schedule, ma y be etta chsd If more space is to qu Ir ed) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE 0ESCRISED POLICIEr> RE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELMERED IN <br /> ACCORDANCE NTH THE POLICY PROVISIONS. <br /> AUTN-IOWED REPRESENTATWE <br /> Colorado Division of Reclamation Mining & Saf0ty <br /> 1313 Sherman Street Room 215 I<aA <br /> [Denver, CO B9903 /4nl� 1 <br /> ACORD 25 (201 10 ) 198 - 015 ACORD CORPORATION. All rights reserved. <br /> The A CIRD rkame and logo are registered marks of ACORD <br />