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GENERAL36256
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GENERAL36256
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Entry Properties
Last modified
8/24/2016 7:56:53 PM
Creation date
11/23/2007 8:40:42 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981015
IBM Index Class Name
General Documents
Doc Date
7/1/1991
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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r <br />c~ ~~~ ~~~~~ ~~ ~~ <br /> <br />INSURANCE TMEPOIICIES DESCRIBED BEIpW ARE SUBIECT TO E%CLUSIONS ANDTHIS VEpIFICAiION OFINSURANCE NERHER AFFlRMATVELY NOR <br />NEGATVELT AMENDS. EYTENDS OR ALTERS THE COV ERAGFS AND/OR E%CWLONS AFFORDED BY OR CONTAINED IN SAID PoIJCIFS <br />NAME AND ADDRESS OF AGENCY <br /> COMPANIES AFFORDING COVERAGES <br />Adams & Porter <br />slo Bering Drive COMPANY A National Union Fire Insurance <br />Houston. texas nosy-loos LE'~rER Com an of P' t b <br /> <br />713!975-7500 COMPANY B <br /> LETTEP <br />NAME AND ADDRESS OF INSURED COMPAN\' <br />- LETTER <br />Ame.riGan,Shield Coal Company COMPANY' I] <br />TTER <br />P.O. Box 1636 LE <br />Silsbee, Texas 77656-1636 COMPANI' T <br />1 <br /> LETTER ~ <br />This is to cemry dial policies of Insunntt fined below have 4en issued m the insured ruined above and arc in force al Ihrs lime. Noswnhslandmg any regwremenl. mnn m rorldwon of any convMl or <br />aher dacumen(wIN rupee[ m which Ws certilcaa rtuY be rssurd or may prnun, Ilrc insurance aHUrdtf by the Pshcm devihd herein a svbJen to all drc rcrms, raduvons nW cvndilions olsuch policies. <br />COMPANY <br />LETTER TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE <br />DATE IMM/DD/1'YI POLICY Ex PIRAnoN <br />DATE IMMIDD/YYI pLL LIMITS IN THOUSANDS <br /> GENERAL LLIBILITY GENERAL AGGREGATE <br />f 1 <br />0 0 0 <br /> r,} <br />LJI COMMERCIAL GE <br />N <br />~RAL LIABILfTT , <br />, <br />A { <br />~ <br />^ CLAIMS MADE )/0.J OCCURRENCE GL5413541RA 4-1-90 4-1-91 AGGREGATEOMP OPS f <br /> ^ <br /> OWNE0.5A CDNTIIACT00.5 PPOTECIIVE <br /> ^ PEPSONAL A ADVERTISING <br />INIURT <br />Sl <br />o <br /> /oo <br />/ <br /> <br /> ^ EACH OCCURRENCE <br />f 1 000 <br /> <br /> ^ <br /> ^ FIRE DAMAGE IANY I FIREI S p 0 <br />J , <br /> ^ MEDICAL EYPENSE <br /> IANY I PERSONI S r) <br /> AVI'OMOTTVE LIABD.IIY csL s <br /> ANT AUTO <br /> ALL OWNED AUTOS BODILY INIURT <br />f <br /> SCHEDULED AUTOS IPER PERSONS <br /> HIRED AIrmS BODILY INJURY <br />f <br /> MONOWNFD AUTOS (PER ACCIDENTI <br /> GAMGE LLSa1LRY PROPERTY <br /> pAMAGE S <br /> EXCESS LIABILITY EACH AGGREGATE <br /> ^ R <br />~ <br />/~ OCCURRENCE <br /> ^ , <br />'~ <br />ryJ F ^^ <br />~ <br />~ I <br /> OTHER THAN UMRRELU FORM e l Ems. ~/ f f <br /> STATUTORY <br /> WORKERS' COMPENSATION J U L O 1 19 1 <br /> S (EACH ACCIDENT) <br /> AND <br /> S (DISEASE POLICY LIMnI <br /> EMPLOYER'S LIABILPTY ,,I <br />AA <br />d <br /> <br />.. <br />~- T ~- ine <br />_ - - <br />-- <br />_ <br />- <br />_ - ~-. <br />_ f-~ .. - rIDISEASE.EACN.ESIPLOYEEI- <br /> oTT~R ec amation Di ision <br />DESCIUPnON OF OPERATIONS/LOCATIONS/VEHICLES/RESfRICT10N5/SPECUL REMS <br />Restoration/reseeding of approximately 7.8 acres in Section 30, Northeast <br />quarter of Township 8 South, Range 101 West (approximately 20 miles north of <br />Fruita, Colorado}, <br />Caa'ellatioo: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor <br />to mail 10 days written notice to the below named ceni(icate holder, but failure to mail such notice shall impose no <br />obligation or liability of any kind upon the company. <br />6 91 <br />NAME AND ADDRESS OF CERTIFICATE HOLDER: DATE ISSUED <br />Colorado Mined Land Reclamation <br />Division <br />1313 Sherman Street, 2nd Floor "~$k <br />Denver, CO 80203 ApencyOfTmcas,InC. <br />FORM A8P IOSB <br />
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