GENERAL30609

• Permit No: C1981024
• IBM Index Class Name: General Documents
• Doc Date: 7/1/1998
• Doc Name: CERTIFICATE OF LIABILITY INSURANCE
• Permit Index Doc Type: INSURANCE
• Media Type: D
• Archive: No

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ACORD
CER I"IFICATE OF LIABI
LITY INSURANCE ogrE (MM/ooyrvl
„
_ _ __06/01/9_8__
PRODUCER ~~~C_DC4JICK OF CAL IFGFtNIA: INC. I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
i~l fTN: LAURA JGIiNS"CIN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
?O1 5. PARKER ST. . SUITE a00/) ALTER THE COVERAGE AFFORDED B_Y TH_E_PO_IICI_ES BELOW.
LIRAIVG?E: r CA 9r PI6F-4 / cU ~ COMPANIES AFFORDING COVERAGE
~ 1 A-2/I a--71~Ot-/ I COMPANY ~~

.-_---___- _. __ ----- A ,JNDERbJfi I fERS INSURANCE CLL. ~
- _
_ _ __
INSURED -
COMPANY
6 COMMERCIAL UN_LTER6JRITE_R5_ INS. __
I(/,I3G'rt NENI'VF2F_S. INC. COMPANY
363:? ~ ;.NLALJI: i=MPIRE DL. r #950 _C _ - _ __ _- _ _
ONI'ARJCJ. CA 91764 COMPANY
I D
COVERAGES
THIS IS 70 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PEP.TAIN. THE INSURANCE AFFO RDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
IXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

CO TYPE OF INSURANCE ~ POLICY NUMBER
LTR _ _ _

__ I -_
POLICY EFFECTIVE PODCY E%PIMTION DMITf
DATE (MM/DDM') DATE (MN/DDM') r
A GENERAL LIABILITY SRGOt1243 6% l)1 /913 h/O1/99 GENERALAGOREOATE S
2i QUO. UO
X1 COMMERCIALGENERAWABILITV _
PRODUCTS-
COMP/OPAGG __
f
r GOO. OOO
1
CLAIMS MADE "' 1000UR _
PERSONALB ADV INJURY _
__
f 1r OUOr UO
OWNER'S 6 CONTRAOTOR'S PROT
I E EACH OCCURRENCE _ f 1 OOO r UO
_
I _ _ I ~
I, FIREDAMAGE(AnyoneAre)
MEDE%PLAnyonepemonl
--
- S SO, OOL
s EXCLVUEL
-
(AUT OMOBILE LIABILI~ ~ECEIVED ~ I COMBINED SINGLE LIMIT S
ANY AUTO -
AIL OWNED AUTOS I'I
J U L O 1 1998 BODILY INJURY
(Per person)
f
SCHEDULED AUTOS _ _ - I
- I
HIRED AUTOS
(BIS J; GCOIDg~
I M
~
'
BODILY INJURY
S
NON~OWNED AUTOS IRQ
~^10D O
' (Per eccltlanU
-_
-- _ -- -_
- ~ --
-- ---- - ~_- PROPERTY DAMAGE S
GAR AGE LIABILITY I AUTO ONLY-EA ACCIDENT f
ANY AUTO OTHER THAN AUTO ONLY: _ __
EACH ACCIDENT S
_
AGGREGATE
I _ _ _
f
I
D E%CESS DABIl1TY SR UOOc R/I _
~J'/OI/9a 6; 01/99 I EACH
OCCURRENCE S1 Or OOOr O17C
1
X UMBRELLA FORM ~ _
__
AGGREGATE _
_ _ SI O_-000r OO/`y1
OTHER THAN UMBRELLA FORM I
S
WORKERS COMPENSATIOX AND -
_
WC STATU~ TTM-
1 TORY LIMITS ~
L
ER
EMPLOYERS' LIABILITY ~
-
. __ _ _ __ _
EL EACH AC(:IOENT
S
THE PROPRIETOR/ INCL
PARTNERS/E%ECUTIVE -
EL DISEASE-POLICY UMIT f
-
OFFICERSARE. EXCL ^_ I _ IEL DISEASE_EA EMPLOYEE S

OTHER __
I - ~ ~ - ~- --

_
DESCRIPTION OF OPERATIONS/LOCATIONf/VEHICLEf/SPECIAL ITEMS I
_ __ _____ I ___ _ _ _ _ _ _ __ _ ____
RE: CULORFtDO COAL P?iNE @ WALSENDERfd ( PSRMIT FJtJ. C-!?t-1:241
CERTIFICATE HOLDER CANCELLATION
SNOUlO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
STATt OF COLORADO E%PIRATION PATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO NAIL
DEPT. C)F NA'f UfiAL RESLJUr I.ES _3OpgY8 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
1313 SFii=RMPN STREET BUT FAILURE TO MAIL SUCH NOTCE SMALL IMPOSE NO OBDOATION OR DABIDTY
DENVER, (_(] BO2O3 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTNORIZE`U HEPR{ESENTATIYE ~}1 ('
ACORD 25-5 !1/951 33- 27 I .. wrnen ~neo~owr....~ . ..
__ - - - ~ __ - .- - _ e .......... ......~.......,.. ~, r~ao
CEPTSS I