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GENERAL30895
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GENERAL30895
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Entry Properties
Last modified
8/24/2016 7:48:19 PM
Creation date
11/23/2007 6:49:42 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980004
IBM Index Class Name
General Documents
Doc Date
6/30/2003
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD <br />~~~~~~~~~~~ ~~ ~A~ <br />~ ~~TY ~N~V~A~~~ DArsIM)Nmmrrl <br />,x I :: 6/26/03 ,.: <br />"PpouucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE ~ CERTIFICATE <br />Acordl• of Kentucky-Lez HOLDER. THIS' CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Loxington 6rean TNO, Suite 410 ALTER THE COVERAGE AFFORDED BY-THE POLICIES BELOW. <br />_._ 2201axl nylon-bream Ci rele ----~ ~ ~----'--' ~ - ~ ~-~ - -~~ ~ COMPANIES AFFORDING COVERAGE <br />Lazl nylon. KY~_40503-3311---~ D COMPANY ~--" ~ '-~-~ . <br />~~ ~~ ~ ~ ~~ ~~ <br />,~ , <br />~.. (859) 273-6600 <br />' <br />- ~ <br />~ /~ Federal Insurance Company . <br />~ ~ ~ ~ ~~ <br />.. <br />. <br />.:. <br />INSURED,. .,.. ., -,. COMPANY '-' <br />~TQ <br />''' <br />bntral Appalachia Yl ni ny, LLC <br />~ ~ <br />3 <br />4 <br />1UN <br />' . P.0 Box 292, <br />- COMPANY <br />Pikeville, XV ~4tsot ~ d Geo1D9Y C ~ ~ --~~ --- <br />e(als an <br />o1 Miy <br />pivision COMPANY <br /> <br /> <br />THIS IS TO CERTIFY THAT THEPOLICIES OF INSURANCE LISTED BELO W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED,NOT W ITHSTANDINGANYREOUIREMENT, TERMOR CONDITION OFANYCONTRACTOR OTHERDOCUMENT W ITHRESPECTTO W HICHTHIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY E%PIRATION LIMR9 <br />LTR DATE (MMIDDIYY) DATE (MMR]DIYY) <br />A GE NERAL LIABR.RY 37111019 5/09/03 5109/04 GENERAL AGGREGATE S 2,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PRODUCTS~COMP/OP AGO f 2,000,000 <br /> CLAIMS MADE ~ OCCUR PERSONAL a ADV INJURY S 1,000,000 <br /> OWNER'S 8 CONTRACTOR'S PROs EACH OCCURRENCE S 1,000,000 <br /> FIRE DAMAGE (My one fire) 3 50,000 <br /> MED EXP (Any one person) $ 5,000 <br />A AU TOMOBO.E LIABO.rDI 73252298 5/09/03 5/09/04 <br /> COMBINED SINGLE LIMIT. 3 <br /> X ANY AUTO 1,000,000 <br /> ALL OWNED AUTOS BODILY INJURY <br /> <br />., <br />~ <br />_ <br />_ _ ....._ .:. <br />(Per person) ._ ...__.._ _ <br />.- - <br />3 <br /> SCHEDULED AUTOS <br /> X HIRED AUTOS ~ BODILY INJURY <br />- <br />3 <br />. X NONAWNED AUTOS - - (Per aCCIdeN) - <br />~ <br /> ~~~ - PROPERTY DAMAGE 3 <br /> .. _ _ <br /> GARAGE LIABRRY - AUTO ONLY ~ EA ACCIDENT 3 <br /> ANY AUTO - OTHER THAN AUTO ONLY: <br /> EACH ACCIDENT S <br /> AOOREOATE~ $ <br /> E%CESS LIABdITY EACH OCCURRENCE S <br /> UMBRELLA FORM AGGREGATE 3 <br /> OTHER THAN UMBRELLA FORM 3 <br /> WORKERS COMPENSATION AND <br />• WC STATU~ OTH~ <br /> EMPLOYERS <br />LIABLm EL EACH ACCIDENT 3 <br /> THE PROPRIETOR/ <br />PARTNERS/EXECUTIVE INCL EL DISEASE~POLICY LIMIT S <br /> OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE 3 <br /> OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIBPECIAL REMS <br />Ye[lane Canyon Yine, Permit N C-80-00 Yunyer Canyon Yine, Permit Ne. C-81-020 <br />C£R.T.1.FI~ATEHpF~DER .....`. .. ..:: . , .~~ ~: CA..t'1.CELLATION.. ...~.: ::: ~~~ .. <br />' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />State o1 Colorado E%PIRATION DATE THEREOF, THE ISSUING COMPANY WBL ENO6NYON(Xtll(MAL <br />Divlsi on of Yl nerals B Geel eyy 30 DAYS WRRTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />7313 Sherman 64., Room 215 - 1fY0DBWIBYR1iXpX1(YMK7BIXMXIItltl(tlYXXYAIXXWONtlBB7Ntl(riB(XBXYIDfTIOB(10NYIBN)f7IX <br />Oenvar, CO 80203 XXXNN%X XXRXXIN9FXi1Xi(1(aRXXIN88WBBNORDl1ltl7L <br /> AU SEN 4 <br /> hllip B. Gibson <br />ACORt?~SS 1195: @ACOAf3~Y)fIPOAAT.AtJIN1SBS: <br /> r.FRnnFleen~ enarnnv nnnna <br />
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