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~onlinenlaLG3sualty Company <br />CNA <br />Fm All thr fam mirmrm. Ynu Mekr' <br />CERTIFICATE OF INSURANCE <br />TTe Policy idenlilied pilaw Dy a pplieY num Oer ie in brce on 1pe date Ol CeniM1Wl@ Isseant¢. Insurance is a11gr0e0 only wtlp ~especl 10 (nose coverages for wp¢h a 9pecdic limit gl liapdny <br />pas peen entmed and i5 sublact to all Ipe lerme of Ipe Policy naving reference Iperlln including Umpr@Ila Excess Tn,rd Pany LiaOrllly Insurance a provision requiring the marnlenence of <br />UnderlylrlQ OS@IaOC! Or 9111 in5urinCe TIIiS t:@rlrh[at2 OI 'nSWanCe neither elLrmalively nor rllgalrvely amind5. lsllOOS nr allr5 lh@ COVeraQ@ allOrded ,Inder any pOLGy i0en111d IlelBiO <br />Name antl Atltlress of Insure0 <br />W. R. GRACE & CO. H-G Coal Company <br />5731 State Highway 13 <br />Meeker, CO 81641 <br />NAME AND ADDRESS OF CERTIFICATE HOLDER <br />3 rma St <br />215 Centennial Building <br />Denver, CO 80203-003 <br />L- <br />Mined Land Reclaimation Division <br />131 She n <br />DATE OF CERTIFICATE ISSUANCE <br />June 29, 1990 <br />J Authorizetl Re0lase^tathe <br />Type of Insurance Policy No. bcp. Date Limits of Liability <br />Workmen's Compensation WC 007413122 6130/91 Statutory <br />Employers' Liability $2,000,000 <br />Comprehensive CCP 001604364 6130191 $1,000,000. C. S. L. <br />General Liability <br />Comprehensive CCP 001604364 6/30/91 $1,000,000. C. S. L. <br />Automobile Liability <br /> ~ ~ I I <br />Description and location of operations of the Insured: All operations of the Insured <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE <br />THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CER- <br />TIFICATE HOLDER NAMED IN THE ABOVE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLI- <br />GATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. <br />G~6168-A <br />