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GENERAL32094
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GENERAL32094
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Entry Properties
Last modified
8/24/2016 7:54:51 PM
Creation date
11/23/2007 7:12:11 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981008
IBM Index Class Name
General Documents
Doc Date
4/23/2004
Doc Name
Certicate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD CERTIFICATE O INSURANCE OP ID DATE (MM/DD/YYYY) <br />WESTE-1 04 21 04 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Hays Companies APR 2 3 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />80 South 8th Street #700 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Minneapolis MN 55402 <br />Phone: 612-333-3323 Fax: 612-373-biYiiOn of Minerals and fj~g~g~RS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Chubb CU9tOm Insurance Co. <br /> INSURER B: Il11nO1S Union Insurance Co. <br />Western Fuels Association,Inc. <br />Robert NorrQard INSURER C: <br />P. O. BOX 33424 <br />D <br />CO 80233 INSURER D: <br />enver <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 ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAV 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 MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD GATE MMIDD/YY LIMRS <br /> GENERAL LIABILfTV EACH OCCURRENCE $ 1 , OOO , OOO <br />A X COMMERCIAL GENERAL LIABILITY 79545130 01/01/04 01/01/05 PREMISES Eaoccurence S 50,000 <br /> CLAIMS MADE ~ OCCUR MED EXP (Any ane person) $ l O , OOO <br /> PERSONALBADV INJURY $S,000,OOO <br /> GENERAL AGGREGATE $2,000,000 <br /> GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000, OQO <br /> POLICY JEC LOC Ben. 1 OOO,OOO <br /> AUT OMOBILE LU161LITY COMBINED SINGLE LIMIT <br />S <br /> ANY AUTO !Ea acci0ent) <br /> ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br /> SCHEDULED AUTOS (Per parson) <br /> HIRED AUTOS <br />BODILVINJURY - <br />$ <br /> NON-OWNED AUTOS (Per ecdtlenl) <br /> PROPERTY DAMgGE - <br /> (Per aaitlent) $ <br /> GA RAGE LIABILTY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: qGG $ <br /> EXCESS/UMBRELLA LIABILRV EACH OCCURRENCE $20,000,000 <br />$ }[ OCCUR ~CLAIMSMADE XOO 621810496 01/01/04 Ol/Ol/O5 AGGREGATE $20,000,000 <br /> E <br /> DEDUCTIBLE E <br /> )[ RETENTION $SO OOO $ <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LUBILITY <br /> ANY PROPRIETOR/PARTNERIE%ECUTIVE -- -- - - - E.L: EACH ACCIDENT - ------ <br /> OFFICER/MEMBEREXCLUDED? E. L. DISEASE-EA EMPLOYEE $ <br /> If yes, tlesaibe antler <br /> SPECIAL PROVISIONS below E. L. DISEASE-POLICY LIMIT $ _ <br /> OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL <br />Evidence of Insurance as respects <br />r~'' _ <br />New Horizon Mine in Nucla, CO (Permit #C-81-008) <br />2 3'23 <br />~ <br />V7 <br />APR <br />Includes use of Explosives <br />Oivi$ion of Minerals and Geology <br />Colorado Mined Land <br />Reclamation <br />Mined Land Division <br />1313 Sherman Street, <br />Denver CO 80203 <br />COLOR-2 SHOULD ANY OF iNE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7HE EXPIRATIOA <br />DATE THEREOF, THE ISSUING INSURER WILL@MAIL 3O DAYS WRRTEN <br />NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT.I(I~C6~OOtYGSHALL <br />RM 215 Ix~~~FkA9F1P/IJQRXR9CMIXX91000ADXIQIE7W67R£K)YX XO>-i01~kX <br />25 <br />
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