GENERAL33918

• Permit No: C1981041
• IBM Index Class Name: General Documents
• Doc Date: 10/4/1991
• Doc Name: Certificate of Insurance
• From: POWDERHORN COAL CO
• To: MLR
• Permit Index Doc Type: INSURANCE
• Media Type: D
• Archive: No

CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY)
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Sad n,:uick JaBle s CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
7f ~~eW Englandi Inc. POLICIES BELOW.
4v =•roaj Street
COMPANIES AFFORDING COVERAGE

COMPANY
A
Attn: ~•~ury 1,=rTc Cn= LETTER
•. :7''lOn.:l Un_On i irs T.nS. CO.
COMPANY B
INSURED LETTER
77"1d^rt~orn C7_1 GO°p=1TY COMPANY
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~ub:idi..ry Of .°:'bOdy C7... CJ. LETTER
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COMPANVD ~` ~ ~ '`~"'
St. LLu,'.5 ~~J ~ J} J j LETTER
COMPANY E _ -`"'
LETTER „~,ir ~ _ -
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY E%PIRATION ~ Lr r'• , Ll~ITS
LTq DATE (MM/DD/YY) DATE (MM/DD/YY)
G GENERAL LIABILITY ~~ L J Z 7 _ _ . i ~ ~ / ~ ~ / jl ~ ~ ~ /' I ~ / ( GENERAL AGGREGATE f ~ ~ V
X COMMERCIAL GENERAL LIABILITY Ij L , X ,: ~ J v :.J .. C T A ~ PRODUCTS-COMP/OP AGG. f ~ ~ iJ
CLAIMS MADE ~ OCCUR. PERSONAL 6 ADV. INJURY S ~ J ~
OWNER'S B CONTRACTOR'S PROT. EACH OCCURRENCE f ~ ~'] C
X 3ro~a f-orm V?n::or5 Cav~r;+_;; i/IClilj_ ~ FIRE DAMAGE (Any one llre) f 1 '
MED. E%PENSE (My one person) S _
A AUTOMOBILE LIABILITY C,a { ~: / f ;) O ~ ~ / ~ / ! . ~ I / ,I ~ / / COMBINED SINGLE
.( ANY AUTO cal ~ Ll ~J ~~7 ( ~rJ/~,v/ d ~ LIMIT f ' cL ~
X ALL OWNED AUTOS L~ T X ~ 1' e. C d r ~ T X J BODILY INJURY

X SCHEDULED AUTOS f
(Per person)
X HIRED AUTOS
BODILY INJURY f
X NON-OWNED AUTO$ (Par acciGenr)
GARAGE LIABILITY
PROPERTY DAMAGE S
EXCESS LIABILITY EACH OCCURRENCE S
UMBRELLA FORM AGGREGATE S
OTHER THAN UMBRELU FORM
WORKER'S COMPENSATION STATUTORY LIMITS
EACH ACCIDENT S
AND
DISEASE-POLICY LIMIT S
EMPLOYERS' LIABILITY
DISEASE-EACH EMPLOYEE f
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS ~~ L L i) P :..`~ T J J.~ L'~' T ~ ' 7 T r T O C . ~ ~ . /
L":~LUT_\G PCW':cKHO'i! CGAL ~C./ ~~!li _iICLI,^. =j ri ~ ~n_S "-n~ri SU2=L'=
CL.aL IYIZI\IN~ C°S.. US_' i.r =n?LL S_V .S Ar" 7C,'•L:Sc TO •!.1'i: 1;_ILS.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
'~ I V .J r M 1 ~I ~ ~ L iI IV l7 .{ . L L a.'I .
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
CCLO~A~O U1V. Of i'J .~T R.S.
HOLDER NAMED TO THE
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AUTHORIZED REPRESENTATIVE
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