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GENERAL30385
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GENERAL30385
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Entry Properties
Last modified
8/24/2016 7:47:56 PM
Creation date
11/22/2007 10:12:40 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981038
IBM Index Class Name
General Documents
Doc Date
7/28/2003
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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Client#: 5934 <br />HORINAT <br />ACORD <br />CERTIFICATE OF LIABI LITY INSURANCE DATE(MNUDD/YVYY) <br />,~ 07/25/03 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Acordia ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />f1 <br />Tower at ErievieW HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />~ <br />~V L// <br />~ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />EC <br />, <br />1301 E. Ninth Street #3800 ~ V <br />Cleveland, OH 44114-7824 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED ~\,` <br />v INSURER A: ZUrICh AmerlCan InS CO <br />Bowie Resources, Limited <br />d GeD\D9V INSURER B: <br />Horizon Natural Resources, LLC Mala\s an <br />ioaotM INSURERC: <br />2000AShIandDrive pivis <br /> INSURER D: <br />Ashland, KY 41101-7058 <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE <br />ATE MM/DD/YY POUCY EXPIRATON <br />DATE MM/DD/YY LIMITS <br />A GENERAL LIABILITY GL0929854903 Q8/29/Q3 Q8/29/Q3 EACH OCCURRENCE $1 QQQ QQQ <br /> X COMMERCIAL GENERAL LIABILITY DAMMG ETO RENTEDn $1 QQ QQQ <br /> CLAIMS MADE OCCUR MED EXP (Any one person) $1Q QQQ <br /> X Blastintl 8<XCU PERSONALBADV INJURY $1 QQQ QQQ <br /> GENERAL AGGREGATE E5 QQQ QQQ <br /> GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $2 QQQ QQQ <br /> POLICY PRO- LOC <br />JECT <br />A AUT OMOBILE LIABILITY BAP319030404 Qtl/29/Q3 Q8/29/Q3 COMBINED SINGLE LIMIT <br /> <br />(Ea accident) $1 ,000,QQQ <br /> X ANY AUTO <br /> ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Per person) $ <br /> X HIRED AUTOS <br />BODILY INJURY <br /> <br />X <br />NON-0WNEO AUTOS <br />(Per accitlenl) $ <br /> PROPERTY DAMAGE <br /> <br />(Per accitlenl) $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANV AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br />A E%CESSNMBRELLA LIABILITY EOG929784104 QQ/29/Q3 QS/29/Q3 EACH OCCURRENCE $25 QQQ QQQ <br /> X OCCUR ~ CLAIMS MADE AGGREGATE $25 QQQ QQQ <br /> <br /> DEDUCTIBLE $ <br /> X RETENTION $1000Q S <br />A WORKERS COMPENSATION AND WC28tIt144OOt1 O8I29/O3 OS/29/O3 X WC STATU- OTH- <br /> EMPLOVERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />- -- <br />~- - ~ - <br />- <br />E1-FACH ACCIDENT - - <br />,$1,000,QQQ- -- <br /> OFFICER/MEMBEREXCLUDED't E.L. DISEASE-EA EMPLOYE E1,000,QQQ <br /> If yes, tlescnbe antler <br />SPECIAL PROVISIONS below <br />E.L. DISEASE-POLICY LIMIT <br />$1,000,QQQ <br /> OTHER <br />DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />Re: Bowie #1 Mine Permit C-81-038 <br />General Liability Policy provides coverage for use of explosives <br />State of Colorado <br />Dept of Natural Resources <br />Div. of Minerals & Geology <br />1313 Sherman Street, Room 215 <br />Denver. CO 80203 <br />SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~~ OAVS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVE <br />MYVr~V L"J ,LVV rlV4I T eT L ifJ474CL/M414b/ YJL. ll MI~VRV VVRf•VRMIIVIY IDOO <br />
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