REV92251

• Permit No: C1980007
• IBM Index Class Name: Revision
• Doc Date: 1/30/1991
• Doc Name: APPLICATION FORM RENEWAL OF A VALID EXISTING PERMIT TO CONDUCT COAL MINING IN COLORADO
• Type & Sequence: RN2
• Media Type: D
• Archive: No

~CERTIFiCA~~F 11~SURANCE
(This Cemficats o} Insurance neither affirmaLVeW nor neganveW
dmind3, eltLend3 pr alters [he COVBragB. IImrt3. Lerm3 Cr COndItIOn3
of the policies it certificatas.l
P' •s to Ceruly to
I
Qb~..1~0(raydDCl4i.tled Idrld I;ecl~tatiDll Aivi cirns
a~A1.a >'i275, (~Jrlfa'A1Tllt ~.
~~ GFIPTTL'iT S~~`
Denver, QJ 80203
~1tt31: :$tf'17HJ I$}7PS
tha[ Ine lollowinq oescribM poilcY Or pplicles, :sued by The Cpmpany at Crxletl below,
prOViding in{pranCe poly for ndddrdS Checkf.V by "X" be1CW, have been I[iued to:
Npryp Atlantic iiehF~ld Cortpan7, iLs Suhsitlla-t~s and suhsidiaries
ADDRESS thereof a§ oar Dr harainarh_r c~rstituted, Atlantic Richfield
INSURED Plater 515 So. Flower Street, Los Angeles, CA 90071
covering in xCbrdanm won tba [erm{ mereol, as me /opowirrg locauonfsl:
C:GNA Proaertv and Casualty Companies

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COMPANY CODES
ZG L'IGNA INSURANCE COMPANY
© CIGNA INS. CO. OF TEXAS
© PACIFIC EMPLOYERS INS. CO
q INSURANCE COMPANY
G OF NORTH AMERICA
Q GGNA 6N5. CO OF ILLINOIS
~ CIGNA INS. CO OF OHIO
G IOTHER: -SPECIFY) FOLC
I TYPE OF POLICY ~HA7ARDS IOa CODE I POLICY NUMBER I POLICY PERIOD ~ LIMITS OF LIABILITY
(al Standard Workmen's statptory w c.
Compensation & I ~ ^ 5 One Accident and
Employers' Liability I
I Aggregate Disease
(bl General Liability ~

Premrsn-Oorra[lons I~nclup:ng "tn.
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ccurrence
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(cl Automahiie Liability
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Nuea Automobiles r: L ~ I "I Aaldenr
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i I '2..'I1l1.0A0 Combined Singfo Li.~it per b¢urtenca
( I 5abjeG to ags:egate of f2,000A00. where applicable.
Cpntrac[ual Foo[no[e: iupiett :C atl :he pOlrcv !erms ]ppncdpie. ipeC iq ^_on:nctuai
Cpver]g2 'f prpvipep 35 refpeC[f ;[ 'f :'r :ntenlrUn pr Ine cOTpdnY chat in the event of C]nCrlldflOr
Check : a WntrdC[ I the CpuCV pr pplgief by !ne CCTpdnY.:en 1101 naW~ written rip
Appliuole1)1 .~ purchase pryer agreemen ti oetween the Insurep any: n[ sucn carceiiauon mii be given [o Vpp at ;ne aopreu stated dboY
Blpek / ^ an comracn 1
NAME OF OTHER P4gTY :ATE ~.: ]ppbuoiel '~ONTgACT NC. (d anV1
Datlnl(rOn{: ~1 n1::UCn1]I tCn:: dC: '••d!'f a.•Y / .: r ~,3aC Uf :'dT.::CS :., '?ftT•!nI a'l: ee^•n. •!e,r n nf.e[:: ~^ n::n Cpnr[••+Cl.an 7"^.-m')' f:On
t wn{ an :Y 3C~]Crnt U ] :]i•1 C]p r:ri )•enlOt•[da~nq :7 nCem n.iY _ ~_'.'C.pol. [': •C+ ]mc:L': end:' ~. •aC[pt m 20n^.r.nn u~tn •Vpr•
:'lr mUn'UCd•::V. ~dl S:C2!r3C{ iCr'ament, Jr f]I +IeYdi Dr mdin (nr,]nCe ++ •°m='1 :.
-_ ._~e- ~ - _ . _
2. I N SU R E'J'S COPY