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GENERAL33856
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GENERAL33856
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Entry Properties
Last modified
8/24/2016 7:55:36 PM
Creation date
11/23/2007 7:44:59 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981041
IBM Index Class Name
General Documents
Doc Date
6/10/1982
Doc Name
Certificate of Insurance
From
FRANK B HALL & CO OF MASS INC
To
MLRB
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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CXOfd <br />NAME AND ADDRESS OF AGENCY <br />Frank B. Hall & Company of Mass., Inc. <br />89 Broad Street <br />COMPANIES AFFORDING COVERAGES <br />COMPANY e <br />Hoaton, Maas. 02110 Ltlitn .. iapLfia{Vp ~.uwErossy VL lYVL V{ nale[lAA <br /> <br /> COMPANY B Pacific Em <br />LETTER <br />l <br /> p <br />oyers <br />NAME AND ADDRESS OF INSURED COMPANY <br />C Old R <br />bli <br />Powderhorn Coal Company LETTER <br />epu <br />c Insurance Company <br /> <br />East of Grard Junction, Colorado COMPANY D <br /> LETTER <br /> COMPANY E <br /> LETTER <br />ihrs is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any repuirement. term or condition <br />of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is sublet( to all the <br />terms, exclusions and conditions of such policies. <br /> POLICY limits of Liability in Thousan s <br />COMPANY <br />LETTER TYPE OF INSURANCE POLICY NUMBER E%PIRATION DATE EACH AGGREGATE <br /> OCCURRENCE <br /> GENERAL LIABILITY <br /> <br />A <br />Q COMPREHENSIVE FORM 6/1/83 BODILY INJURY f f <br /> <br />^ TST. ZO9168 <br /> PREMISES-0PERATIONS PROPERTY DAMAGE f f <br /> ^ EXPLOSION AND COLLAPSE <br /> HAZARD <br /> ^ UNDERGROUND HAZARD <br /> ^ PRODUCTS/COMPLETED <br /> OPERATIONS HAZARD <br />^ BODILY INJURY AND Z OOO <br />f Z OOO <br />~ <br /> CONTRACTUAL INSURANCE PROPERTY DAMAGE f f <br /> ^ BROAD FORM PROPERTY COMBINED <br /> DAMAGE <br />^ INDEPENDENT CONTRACTORS <br /> ^ PERSONAI INJURY PERSONAL IN JURY f <br /> AUTOMOBILE LIABILITY BODILY INJURY <br />f <br />A 0 6/1/83 (EAOH PERSON) <br /> COMPREHENSIVE FORM BODILY INJURY f <br /> <br />owrcD <br />CAL 484438 (EACH ACCIDENT) <br /> ^ HIRED PROPERTY DAMAGE f <br /> <br />NON-0WNED BODILY INJURY AND <br />PROPERTY DAMAGE <br />f 1,000 <br /> f,OMBINED <br /> E%CESS LIABILITY <br />B UMBRELLA FORM <br />® TO HE DETQ2lIINID 6/1/83 BODILY INJURY AND <br />PROPERTY DAMAGE <br />fS <br />000 <br />000 <br />f 5 <br /> ^ OTHER THAN UMBRELLA COMBINED , , <br /> FORM <br /> WORKERS' COMPENSATION STATUTORY <br />C and TO BE DElFR!lII~U 7/1/83 <br /> EMPLOYERS'LIABILITY f 10~ Icx~<cuolRn <br /> OTHER <br />)ESCRIPTION OF OPERATIONSJLOCATIONSNEHICLES <br />Cancellation: Should any of the above described policies be cancelle~fl~Trta?~xpl~'afio~~}p~reof, the issuing com- <br />pany will ~dOmmtatlOt:mail ~_ days written notice to the below named certificate holde~ybpip~Q <br />NAME AND ADDRESS OF CERTIFICATE HOLDER: <br />Colorado Department of Nntural Resource3 DATE ISSUED: <br />Mined Reclamation Board F.H. Hall & Co. of Mass., Inc. <br />Mined Land Reclamation Development ~: <br />~ <br />1313 Sherman Street ~ <br />Denver, COlOradO BO203 AUTHORIZE REPRESENTA <br />ACORD Tf (1~J9) <br />
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