GENERAL34758

• Permit No: C1981022
• IBM Index Class Name: General Documents
• Doc Date: 8/30/2002
• Doc Name: Certificate of Insurance
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

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ACORD ~ '.
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,. 08!28!02
PRODUCER THIS CERTIFIGATE IS ISSUED AS A MATTER OF INFORMATION
ADn Risk Services, Inc of Florida ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
222 Lakeview Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Suite 510 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
West Palm Beach FL 33401 COMPANIES AFFORDING COVER
AGE
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COMPANY
T~CC- -
A Federal Insurance Company ~~V
' PHONE - [phone] FAX - [phone] F
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INSURED C-$~-(~Z co BANV Up 3 .
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"' Oxbow Carbon & Minerals, Ina.
co
OY N`Sj°
Attlr Donna J! Gulbransen C
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West Palm Beach FL 33401-8101 USA COMPANY ~ 6 G
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFIGATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POWC1'NUMeER POLICY EPFECT'fVE POLICY EXPIRA770
' LLY/nS
LTR DATE (MM/DDNY) DATE (AfM11/OD/1'1
)
A GENERAL LIABILITY 37104288 09101!02 09!01/03 GENERAL AGGREGATE $2,000,000
X
DDMMERDVLL GENERAL LIABILITY
General Liabilly
PRODUCTS-COMPlOP qGG
$1,000,000
CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $1,000,000
OWNER'S&CONTRACTOR'8 PROT EACH OCCURRENCE $1,000,ODO
FIRE DAMAGEIAnV One fire) $100,000 ',
MED EXP (Any ane cersoN $1 Q 000
A AU TOMOBILE LIABILITY 7307-72-58 09/01!02 09/01/03 COMBINED SINGLE IIMR $1
000 ODQ '
$ ANY AUTO BUSIne55 AUtODWbiIB , I
ALL OWNED AUTOS BODILY INJURY I
SCHEDULED AUTOS (Per psrson) I
HIRED AUTOS BODILY INJURY _ _ I
.NON-OWNED AUTOS ~ (Par eccidenq
PROPERTY DAMAGE

GARAGE LU1BILnV AUTO ONLY - EA ACCIDENT
ANV AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGAT
EXCESS LIABILITY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
VJC STATU- nTH- t ` g' m
~MORRER'S COMPENSATON AND_ _ _ . _
~
EMPLOYERS' LIABILITY EL EACH ACCIDENT
THE PROPRIETOR/
PARTNERS/EXECUTNE INCL
EL DISEASE-POLICY LIMIT
OFFICERS ARE: EXCL
EL DISEASE-EA EMPLOYEE

SCRIPTION OF OPERATIONSILOCATIONSMEHICLES!SPECIAL ITEMS
WTi C . , Q = ER CA't C°-EL R~O° ~i
SNOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELlEO BEFORE THE
Division of Minerals & Geology EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Attn: Bill Carter 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
1313 Sherman Street, Room 215 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGRTION OR LIABILITY

Denver CO 80203 USA
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. i

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AUTHORIZED REPRESENTATNE ~ / ~~ I
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