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GENERAL33553
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GENERAL33553
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Entry Properties
Last modified
8/24/2016 7:55:28 PM
Creation date
11/23/2007 7:40:37 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981010
IBM Index Class Name
General Documents
Doc Date
3/21/1983
Doc Name
PROPOSAL OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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'~ McG+S+W <br />1 <br /> <br />1 <br /> <br /> <br />1 <br /> <br /> <br /> <br /> <br />1 <br /> <br />This is to Certify That <br />McGRIFF SEIBELS & WILLIAMS, INC. <br />~, [Jj[~(~"jEi'~ RRf1IKF.R4 <br />2211 7th Avenue, South/Birmingham, Alabama 35233 <br />P.O. Box 10265/Birmingham, Alabama 35202-0265 <br />TEL-(205) 252-9871 TLX-5-9821 MACSEIB BHM <br />Certificate No. <br />MSB C 618 t <br />as broker for [he Named Insured, has procured the insurance coverage described below with the Insurance Company shown on <br />Certificate. <br />NAMED INSURED AHD MAILING ADO RESS <br />TRAPPER MINE INC. '] <br />P.O. BOX 187 DATE: 12-3-82 <br />CRAIG, COLORADO 81626 <br />L J <br />OR ABOUT <br />EFFECTIVE DATE Beginning at 12:01 A.M. on the 6TH da~ of JANUARY Ig83 <br />and ending atPENDING RECEIPT on the OF POLIO ~f Ig_ <br />Standard time at the place of location of risks insured. <br />SAFETY MUTUAL CASUALTY CORPORATION <br />UMBRELLA LIABILITY $5,000,000 EXCESS PRIMARY <br />TERMS AND CONDITIONS AS PER ATTACHED <br />PER: CHARLIE GARRISON - E & S FACILITIES <br /> <br /> <br />Acting upon instructions from the Insured, and in consideration of the payment of the premium shown above, which is an esti- <br />mated premium, this Certificate has been issued to evidence the insurance coverage procured until this Certificate is cancelled <br />by written notice to the insured or is replaced and thereby terminated, by the formal contract of insurance to be issued by the <br />Insurance Company. Coverage evidenced by this Certificate is in accordance with the standard policy and forms in use by Ule <br />Insurance Company as of the effective date of this Certificate and is subject to all terms and conditions of said contract. <br /> ~,L,T~rj$, jN(' <br />~!iAF: <br />i R gy <br />MCCRIFF, <br /> <br />J.~.a_+1 / <br />- <br />/ <br />$y r/~2~L4a ~~/LA~fd'~/~ <br />~a a~ [a . <br />
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