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T~ r <br /> <br />ACORD ~ <br />CERTIFICATE OF INSURANCE i III IIIIIIIIIIIII III ' <br />°"'~'"""'°°"'~' <br />~ <br />~ <br />. _________ <br />7 / 0 9 / 9 6 <br />.. ._ _._. __ _. _ __ __. ...__ _ . _ _.____. _. _._...__ ..______ ~ 999 <br />~DOL~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />S e d g w i c k James o f T N, Inc . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELON. <br />P. 0. Box 1 9 8 1 0 COMPANIES AFFOFU)ING COVERAGE <br />Knoxville, TN 37939-2810 COMPANY <br />423-584-9101 A Federal Insurance Co. <br />INSUi€D COMPANY <br /> e r~~r <br />WILLIAMS FORK COMPANY COMPANY JUL 15 <br /> <br />P 0 BOX 187 n <br />C 19d~ <br />CRAIG C O 8 1 6 2 6 COMPANY <br /> D <br />COVERAGES O D9Y <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED iOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTNITHSTANDI NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT I•IiTN RESPECT TO WHICH TH15 <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />~ <br />LTR TYPE OF 1lLSURIWCE PODCY NUMBEN POIX.Y EFFECTIVE <br />DATEQ.IMIDOVYY) POULY FJIPIRATION <br />DATEIAIAVDD/1'Y) DAAnS <br />A GEW E7NL LIABNTY 3 7 1 0 D 0 1 8 1/ 2 0/ 9 6 )/ 2 O~ 9 7 GENEPALAGGREGATE t 2 0 0 0 O O O <br /> X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG 6 <br /> CLAIMS OCCUR <br />MADE X PERSONALS ADV INJURY S <br /> OWNER'S a CONi PROT EACH OCCURRENCE S l o a D D a o <br /> FIRE DAMAGE (Any one flre) 5 D <br /> MEDEXP (Any onepmson) y 1 D D D D <br /> AUTO lI~E LIABNTY <br /> COMBINED SINGLE LIMIT E <br /> ANV AUTO <br /> ALL OWNED AUTOS BODILYIWURY <br /> <br />SCHEDULED AUTOS <br />(Per penon~ E <br /> HIRED AUTOS BODILY INJURY <br /> NON~OWNED AUTO <br />Per eccitlentl <br />~ <br />t <br /> PR <br />PE S <br /> O <br />RTY DAMAGE <br /> GMAGE LY1®IIY AUTO ONLY ~ EA ACCIDENT S <br /> <br /> _ ANY AUTO OTHER THAN AUTO ONLY: <br /> EACH ACCIDENT 9 <br /> AGGREGATE S <br /> IXCE55llABSTIY EACH OCCURRENCE 8 <br /> UMBRELLA FORM AGGREGATE E <br /> OTHER THAN UMBREt1A FORM <br /> VAYaOAAN'S COMPENSATION AND <br />FAIPLOYERS LIABILITY ~ STATUTORY UNITS S <br /> <br /> EACH ACCIDENT S <br /> THE PROPRIETOFL <br /> <br />PARTNERS/EXECUPVE INCL DISFl,SE-POLICY LIMIT <br />5 <br /> OFFICERS ARE: E%CL DISEASE ~ EACH EMPLOYEE ~ <br /> OIHFTT <br />DESaaPTION °F °PEnuTI°NSn°rwTTOraSrvEr^°esrspE°^~ nE~AS Insurer w i l l notify division w h e n e v e r <br />substantive changes are made in the policy including termination or <br />failure to renew. This policy applies to permit MC-81-010 and includes <br />coverage for Property Damage and Personal Injury resulting from the <br />CERTIFICATE HOLDEA use a e x O s I v e CANCELLATION <br /> SHOULD ANY OF 7F¢ ABOVE OESCWBm POLIOES BE CANCFIIID fgF01€ 1HE <br />COLORADO DEPT O F NATURAL RESOURCE 5 EDwmnnoN DATE THBEOF, THE ISS111M' cawaNr VAU IfTT) uwL <br />DIVISION O F MINERALS 8 GEOLOGY ] 0 DAYS xavrrETL NOTICE ro TI¢ GII{To-x~LTE HOIDEFi NAA® TD THE LEFT <br />ATTN JOSEPH DUDASH ®OO <br />215 CENTENNIAL BUILDING <br />1313 SHERMAN STREET ... ... <br /> <br />DENVER CO 80203 <br /> <br /> <br />_. ._. _ _ _.._.. .._._._.-. _ -.. --_- _. <br />AUIHOWZED -1 1 ~arC~~ <br />/~ / G~I~ <br />-. _.. ._ _.-_.~fj//.~ ._ _ <br />.. - <br /> <br />ACORD 25S 3/93 2 - 2 3 -- <br />__ <br />- - - @ACORD CORPORATION 1993 <br />v. <br />