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GENERAL34858
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GENERAL34858
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Entry Properties
Last modified
8/24/2016 7:56:07 PM
Creation date
11/23/2007 8:04:39 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1984062
IBM Index Class Name
General Documents
Doc Date
9/7/1994
Doc Name
Certficate of Insurance
From
ENERGY INSURANCE INTL INC
To
DMG
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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_ u <br />' (~~rfifi=Ate a~ ~nBUrAnT~ <br />To: Division of Minerals & Geology oet•: Sepcember ~, 1994 <br />Addre.t: Deparement of Natural Resources Re0 See Attachment <br />1313 Sherman St., Room 216 <br />Denver, CO 80203 <br />Thin Ir to certify that She policlen dealgneted below are in force on Lhe date borne by thit Cart ificete. <br />NAME OF INSURED: <br />Addror: <br />YVeE <br />w <br />POLICY LIMITS/VALUea <br />A) Commereiel Gelaeea] Llabllfry - 04/01/94 - 56,000,000 Geaenl Aggregate <br />XCU ~Clalms Medo, GL3197123 ~/Ol /93 56,000,000 P ~ ~ »tQieted Opantloag <br />Repo Date: 7/1/x6 GL3197127 52,000.000 Petaooel cad Advettitdag Iajllry <br />a) All Senses f2,000,000 Each Ooeatrmee <br />b) 'l~u 52,000,000 Fite Detasge (Aar One Piro) <br />S 10,000 Medici! Sapmee (Any One <br />Petatm) <br />B) wuto Liabiliry 04/0!/9a _ 52,000,000 CSL Hach Oocumaoe <br />a) All States CA1431816 04/01/93 <br />b) Tegu CA3431g19 <br />c) worketa~ Compmsadtm 09/01/94 - wc: sraaftory <br />Bmployan' Liability 09/01/93 8L: 52,000,000 Each Aecideo[ <br />Calffornfe Only 0016120-02 52.000,000 Diteasas -Polley Llmf! <br /> 52,000,000 Disease -Bach Employee <br />D) Workers'Compaeeatim 09/0?194- WC: Sbtutory <br />Hmplrayer>,' Liablliry 09/01/93 HL: 52,000,000 Beeb Aoeidea! <br />Olhx 9taLes 0016176-02 52,000,000 Dlaeeae -Policy Limit <br /> 52,000,000 Disease - Eeoh 8mployee <br />E) Bltoeee Workan' Contpaogatlon •8X-333 09/01/94. Compmy's Limit of htdel>®ity Bach <br /> 09/01/93 Oeaareeee: Statutory <br /> Self Itamted Retention: SI,000,000 <br />Thle certl}icate of insurance neither af}irmetlvaly nor negatively emends, entenda or eltera She covarege afforded by those pellcv (lea! <br />which numbered above end which issued by com peniee Ilated below. <br />INSURANCE COMPANY(IESI <br />1H8VING COVERAGE: <br />A)B) National Union Fire Ina. Co. <br />C)D)S) Old Republic Insurance Company <br />ay <br />Iew,Lea <br />Cyprus Amex Minerals Company et al including Subsidiary Companies <br />4100 Past Mineral Circle <br />Englewood, CO 80112 <br />2000 Bering Dc, Suite 900 <br />Houecon. Te>aea 77057 <br />P.O. Boa 36429 <br />Roueron. 1LIru 77236.6129 <br />Phone- 71J /763-66x0 <br />Telex 791 393 <br />lnCl. Tele>< 166 26] or 166 264 <br />Telecopler 71S/76S-72L1 <br />Eiz'd 'I'I'3 Tb2L EBL(ETL) WdZb:20 b6. L0 d35 <br />
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