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REV06016
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REV06016
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Entry Properties
Last modified
8/25/2016 1:04:44 AM
Creation date
11/21/2007 9:30:36 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981038
IBM Index Class Name
Revision
Doc Date
7/9/2004
Doc Name
Insurance Certificate (E-mail)
From
Jim Stover
To
DMG
Type & Sequence
SO4
Media Type
D
Archive
No
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JUL-09-2004 09 04 AM APPALACHIAN FUELS 16069280454 P, 01 /02 <br />CERTIFICATE OF LIABILITY INSURANCE esR Tx °"TE'N""°°"""' <br />.9CO <br />RD <br />. <br />.. <br />sowl8-1 07 oe o4 <br />PROBUCER TINe CERTIFICATE NI 488UE0 A9 A MATTER OF INFORMATbN <br /> ONLY AND CONFERS NO RIG1fT8 UPON THE CERTIFICATE <br />Putaem Ageaay, Ina. XOLOER. THIS CERTIFICATE bOES NOT AMEND, EXTEND 011 <br />P. O. Sox 991 ALTER TXE COVERAGE AFFORDED BY THE POLICIES 9ELOW. <br />Aahlaad RY 41105 <br />Phoae~606-329-2200 pax1606-325-7787 INSURERBAFFORDINGCOYSRAGfi NAIC• <br />INSURED INBURERA Federal iAR• Co. <br />_- <br /> INSURGR a: ATneriaaa 8mgire 2ne. - MFi <br />8owie Resources, LLC <br />Jeff Mun IN$URERC: yianaCOl Aa9uYaaOe <br />.._... ..........__..--_-..._.._ <br />__ <br />n <br />gg <br />snd5XY7 4110 5 <br />O <br />50 57 <br />h <br />1P INSURERD~ LlLryd's Of LondLm <br />L <br />- <br />e <br />l <br /> INSURER E: <br />COVERAfiES <br />THE POLIC68 OF RJ$UMNC6 LISTED BELOW NAVE BEEN ISSUED TO TIE INSURED NAMED ABOVE FOR THE POLICY PERIOD PIPIGTED ,UiWIT113TMIPING <br />ANY REOUIREYENT, TERY OR CONORION OF ANY CONTRACT Ofl OTHER OOCVMENT W Ini RESPECT TO W HIGH THRi CERTIFICATE MAV BE ISSUED OR <br />MAY PERTAN, THE INSURANCE APFORDEO BY THE POLN:IES DESCRIBED HEREIN IS SVBJL'CT TO ALL TNC TERMS, EACLli810N$ ANO CONDRIONS OF SUChI <br />PpLIGE9~ AGORFPATE LNAR9 SNDWN MAV HAVE BEEN REDUCED BY PAIp CLAIMS. <br />~_~~~_-~Pa[cY EFFECTNC FDI. <br />-- <br />LTR TYPE OF NMURANCE POLICY NOMBER LIMR t <br /> OENERALLUBB.ITV EACH OCCURRENCE f 1DODDDO <br /> <br />A <br />X <br />COAaIERCML DENERAL LMBILRY <br />37111143C8i <br />02/01/04 <br />02/01/05 <br />PREMWF$a,Ea~o_~_+~_ ___ <br />t 1000000 <br /> - ._...- <br />ClAIM3MADE uOCCUR <br />MEO E%P(Myane pereonl <br />f10D0D <br /> PERSONALBADV tt11URY t 1000000 __ _ <br /> OENEPAL 40GREGATE f 2000000 __ <br /> OFN'I AOt#YEGATE 41LIITAPPI.IE5 PER' PNODUCTS-COMPIOPAOG f 1000000 <br /> PGUCY ~~ LDL Bab. 1DD0000 <br /> AUT OMOdLE LIAE0.ITY COMBINED 9INPLE LIMIT i1DDDDDD <br />A X ANYAUTO 79526270 01/31/04 01/31/05 (6i aclaenB <br /> ALL OWNED AUTOS B090.Y INJURY <br /> BCNEWLEP AUT08 (~ ~IaMil <br /> <br />__ HIRED AUTO6 <br />BOPRYINJURY <br />t <br /> NON-0W NED AUTOS (Del xtltlMll <br /> ... ... . .. ... ................... PROPERTY DAMAOE <br />t <br /> (Del eccltlenU <br /> OARAOF LWB0.RY AUTO ONLY ~EA ACCIDENT i <br /> ANY AUTO OTHEP TNAN E.L MC i <br /> AUTO ONLY: qOG i <br /> ERCE88AlMBR0.LA DABILRY EACH OCCURRENCE f SDDOD OO <br />$ X OCCUR l CLNMSMADE 4CD11917 02/01/04 OZ/O7/OS AuofleBATF ____ s <br />_____.-.__ _ <br /> f <br /> OEDIICTIBLE __ _ i <br /> X P6TENTUN t0 tion f <br /> WORNep3 cPMPENMTpIN ANP TORY LI <br />alt <br /> <br /> <br />C <br />EIiLOYERf' LU1BIlITY <br /> <br />4077358 <br /> <br />03/01/04 <br /> <br />03/01/05 __ <br />_. <br />.. <br />E.L. EACH ACCIDEM .. _. ... . <br /> <br />t 1000000 <br /> 0.NV PROPNIETORIPARTNER/F%fiClR1VB -------------- -. - <br /> OFFICERIMEMBERExClUOED'I E.L. OISEASE~EA EMPLOYE f1DD000O <br /> Il yyppaa deecnne antler <br />SPEGIIAL PROVISIONS GebN ... <br />E.L. DISEAS[~POLICV LIMR __._ <br />SIOO DDDD <br /> OTHER <br />D 8quipment Floeter 8105804RBOM0954 0]/09/04 01/01/05 $1000 Dad $100,000 <br /> Rented Leas <br />DESCRIPnON OP OPERATMINS I LOCATIONS I VEWCLES I ENCLUSEINE APPEP PY ENPOREEMENT 1 EPE041L PROVIaDNB <br />Pezmit 1fC-81-030 <br />8TAT813 BNDULP ANY OF THE ABOVE PE84RIEE0 POLICRFB BE CANCELLER BEFORETHE <br />OAT6TWREDF, TNEIBSDING INSURER WB-4~~MNL 10 BAYI <br />State Of COlOYadO <br />Division o£ Minerals a deology <br />1313 Sharman Street, RM 215 <br />Deaver CO 80203 <br />
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