PERMFILE60920

• Permit No: C1981033
• IBM Index Class Name: Permit File
• Doc Date: 2/1/1981
• Doc Name: Permit
• Section_Exhibit Name: 1981 ORIGINAL APPLICATION
• Media Type: D
• Archive: No

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CXOfCJ_ r
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,
•~nM[ AND ADDRESS OF AGCNCY
Figure 2.03.9 (1)-1 COMPANIES AFFORDING COVERAGES
McCaski 11-King COMPANY
A
2111 30th Street LETTER
St. Paul
Boulder
CO 80301
, GOMPA„Y B
L(IICH
.'ML n„D pUDRC55 Or INSURCD
COMPANY
Bear. Coal Co., Inc. LF rTER y
dba Bear coal Co. COMPANY D ,
Somerset, CO 81434 `F"`R
COMPANY C
LETTER C
r:lis is to certity that Policies of insurance listed below have been Issued to the insured named above and are In force at this time. Notwithstantlingsny repuiremenL term or condition
II any contract or other document with respect to which this certificate may be Issued o r may pertain, the insurance aHordetl by the policies described herein is subject to all the
P.ms. a%clusions and conditions al such policies
PAm
~ PnElcr Limits of Liabilit in Thousand s I
a
'MICR iYPC OF INSURANCE F`OLICV NUMBER I%PIHPTION DAIC EACH AGGRCGAIC
OCCURRCNCE
GENERAL LIABILITY
Booiw vuu4v s s
/1 COMPRCHENSrvE FORM

583JK0481 p
8-11-81
PREMISCS-OPERAl10N5 PROPERTY DAIAAGE f S
^ C%PLOSION ANO COLLAPSC
HAZARp
^ UrvOERGROUND HAZARD
^ PAODUCi S/COMPLETCD
OPERATIONS HAZARD
^ BODRY INJURY AND
5 ~ 0
S O O
CONTRACTUAL INSURANCE PgOP(RTY DAMAGC l S
^ BROAD FORM PROPERLY COMBINED
^ DAMAGE
INDCPENDENi CONTRAC LORS
^ PCR50NAl INJURY PCR50HAl IN JURY S
AUTOMOBILE LIABILITY BODRY INJURY S
(EACH PERSON)
^ COMPRCMENS WC FORM BODILY INJURY f
^ OwNED (EACH ACCIDENT)
^ HmED PROPERTY DAMAGE S

^ BODILY INJURY AND
NON~OwNCD PROPEAtt DAMAGE 3
COMBIrvCD
EXCESS LIABILITY
BODILY INJURY AND
^ UMBRELLA FORM pROPCRTY DAMAGC S f
^ O1 MCA iHPN UMBRCLLA COMBINED
FORM
WORKERS' COMPENSATION sTnTUroar
and

_ EMPLOYERS' LIABILITY s
¢x~+cnoum
OTHER
:I SCRIPiION OF OPERATIONS/LOCATIONSNEHIClES
Cancellation: Should any of the above described policies be cancelled before the expiration date thereol, the Issuing Com-
pany will endeavor to mail _,10- days written nonce to the below named certificate holder. but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRC55 OF CE Ri 61CA1 C HOLDCR
Leroy Black DATE IssDED
Ute Engineering 6 Surveying
P.O. Box 674
Delta, CO 81416
AUTHORIZF LTA VE

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