GENERAL32601

• Permit No: C1980007
• IBM Index Class Name: General Documents
• Doc Date: 12/1/1986
• Doc Name: Certificate of Insurance
• Permit Index Doc Type: INSURANCE
• Media Type: D
• Archive: No

~ INSURANCE COMPANY OF NORTH AMERICA III IIIIIIIIIIIIIIII
''December 1, 1986 GROUP OF INSURANCE COMPANIES
CERTIFICATE OF INSURANCE yyB
(This Certi/irate of Insurance neither altirmatively nor negatively amends, extends
or alters the coverage, limits, terms or conditions of the policies it certlf,cates.l
This is to Certify to
Colorado Mined Land Reclammation Division
Room 423, Centennial Boulevard
1313 Sherman Street
Denver, Colorado 80203
L J
that the following described policy or polities, issued by The Company as coded below,
prov,ding ,nsurance only for hazards checked by "X" Delcw, have been issued to:
NAND Atlantic Richfield Company, Its Subsidiaries and subsidiaries
ADDRESS, thereof as now or hereinafter constituted, Atlantic Richfield
INSUREDI/ Plaza„ 515 So. Flower Street, Los Angeles, CA 90071
covering in accordance with the terms thereof, at the following locatlonlsl:
Including Anaconda t7inerals -Coal
COMPANY CODES
© CIGNA INSURANCE COMPANY
^3 INA OF TEXAS
5^ PACIFIC EMPLO VERS INS. CO.
INSURANCE COMPANY
OF NORTH AMERICA
^A INA INS.CO. OF ILLINOIS
^B INA INS. CO. OF OHIO
FOLD
^ (OTHER:-$PECIFVI
TYPE OF POLICY OQ OODE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY
(a) Standard Workmen's statptpry w. c.
Compensation & ~ ~ $ One Accident and
Employee' Liability Aggregate Disease
(h) General Liability
Premises-Operations (including "In-
" ® ® $ Each Person
cidental Contracts
as defined below)
~ ^ Accident
'~ Independent Contractors ® ® SCG GO 01-01$7 t0 $ *See Each ~ ^ Occurrence
c Completed Operations/Products ® ® 9690657 01-01-90 Below
m
Contractual, ISlaeclf,c Type as
f
d
®
® Aggregate--Completetl
escribed in
ootnote below) _ _ _ _ _ _ _ _ _ _ _ _ $ _ _ _ _ Operations/Products `
Premises-0Perations (l ncluding ^ Accident
"Int,den cal Contracts" as del,ned
©
~ Each
n
$ ~ ^ O
below) ccurre
ce
E
0
Independent Contractors 9 SCG GO O1-01-87 to *See
$ Aggregate-Prem./Oper.

u 9690657 01-01-90 Below
$ Aggregate-Protect.ve
o° Com feted O erations/Products
p p
®
$ Aggregate-Completed
n
Contractual, (Specific type as

®

® Operations/Products
described in footnote below) $ Aggregate-Contractual
(c( Automobile Liability
Owned Automobiles SCA 010862 Ol-01$7 t0 $ *See Each Person
T
o.o Hired Automobiles
~
~ p1-01-90 BeIOW (^ Accident
Each i
m
Nono_wned Automobiles , _ _ _ _ _ _ _ _ _ _ _ _ _ $ _ _ _ _
^ Occurrence-
rrr _ _ _
e Owned Automobiles
~
g SCA 010862 Ol-01$7 t0
9Q
Q1-01 *See
1 ^ Accident
BeIOW Each ~
)
o n Hired Automobiles - $
^ Occurrence
1
°~ Nonowntd Automobiles © f
•2,000,000 (.o biped Single Limit per oc trance subject to aggregate of
j2,01X1,OfX1 wh a applicable. This Policy vets all operations in ell States
Contractual Footnote: Subject to all the polity terms applicable, ipecitic contractual
coverage is providetl as respects It is the intention of the company that in the event of cancellah on of
Check ~^ a contract the policy or polices by the company, ten 1101 days' wnnsn notice
Applicable ^ purchase order agreements between the Insured and: of such cancellation will be given to you at the address stated above.
Block ^ all contracts
OF OTHE. t Pq RT V
IPT
DATE lit aDPncapiej
1~
DNinitions: "Inudemal contract" means any written 111 lease of premises 121 easement agreement, a:cept C nn n w~i~ryya~co~ns~lr~u Lion or demol~i.; ~+ no~
cons on or adlacent to a railroad, 131 undertaking w mdemn~ly a mumupabty requ ued by mu rd nc\' "a s• w,th : ro
the mun ¢ipabty, 141 s,detrack agreement, pr 151 elevator maintenance ayreement. s
GBOrgB MCMaRUS Au monied Represematrv,
LC~t389e Ptd..n 11.5 A 1. ORIGINAL