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GENERAL30839
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Last modified
8/24/2016 7:48:17 PM
Creation date
11/23/2007 6:49:08 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981039
IBM Index Class Name
General Documents
Doc Date
3/31/1982
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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IANBRELLA LIABILITY: <br />Policy No. Inception Date <br />Insuring Company <br />Single Limit Liability: $ <br />Expiration Date <br />tention: <br />OWNER'S PROTECTIVE OR RAILROAD PROTECTIVE LIABILITY: <br />Policy No. Inception Date <br />Insuring Company <br />Name E Address of Insured <br />Expiration Date <br />Limits of Liability: <br />Bodily Injury Liability <br />Property Damage Liability <br />SPECIAL COVERAGE: <br />$ Each Occurrence Combined <br />$ Each Occurrence OR Single <br />$ Aggregate Limit <br />Policy No. Inception Date <br />Insuring Company <br />Name 6 Address of Insured <br />ration Date <br />Amount Deductible <br />MORTGAGE CLAUSE: <br />Loss, if any, to be adjusted only with the insured named herein and payable to the insured b <br />as their respective interests may appear, subject, nevertheless, to all the terms and condi- <br />tions of the policy and the Standard Mortgage Clause, U. F. Form No. 127 B (9-34) <br />CANCELLATION: Should any of the above described policies be canceled before the expiration date <br />thereof, the issuing company will mail 30 days written notice to the below named certificate <br />holder, but failure to mail such notice shall impose no obligation or liability of any kind <br />upon the company. Colorado Department of Natural Resources <br />Mined Land Reclamation Division <br />1313 Sherman St. <br />Denver. CO 80203 <br />This cer_t.if_icaie_i.s.-issued-as-a matter of-information-only and confers no rights upon the - <br />certificate holder. This certificate does not amend, extend or alter the coverage afforded <br />by the policies listed above. <br />Bituminous Casualty Corporation _St. Paul Fire & Marine Insurance Company <br />~_Bituminous Fire E Marine Insurance Co. United States Fire Insurance Company <br />General Casualty Company of Wisconsin United States Fidelity b Guaranty Company <br />Regent Insurance Company Fidelity E Guaranty Insurance Underwriters, Inc. <br />_Maryland Casualty Company _Hawkeye Security Insurance Co. <br />-~~ ~ i~ <br />Countersigned By: <br />of b for alist-Kline Agency, Inc. <br />P. 0. Bo 6 <br />Middlet Wisconsin 53562 <br />Authorized Representative <br />
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