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,acoao <br />! CERTIFICATE OF INSURANCE j ~II II~~I~II~~~~~~I~ ~~ °"'~'""'"'°°'"" <br />__ . <br />_ _ _ _ _- .._ _ 999 I: 9/05/96 <br />PROOU~ THIS CERTIFICATE IS ISSUED AS A MAI ItH ut INFORMATION <br />ONLY A10] 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 CAMPANIES AFFORDING (AVERAGE <br />Knoxville, TN 37939-2810 COMPANY , <br />423-584-9101 A Federal Insurance Co. <br />MSUREU COMPANY I7 ~ ~~ E ~v t <br /> B Fp '1 7 inn `~ <br />- <br />Williams Fork Company ITS <br />COMPANY ~~ <br />P.O. Box 187 C <br />Craig, CO 81626 C0IAPANY <br />l <br />P ~CUIb~Y <br /> o <br />D (=lirlo~on of ~~Indra <br />NVEMGES <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT KITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR NAY PERTAIN. THE INSURANCE AFFORDED BY THE POLIC SES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />E%LLUSIONS AND CONDITIONS OF SUCN POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 0Y PAID CLAIMS. <br />~ <br />LTR TYPE OF RLMVWCE <br />-~ POUC1'NUMRQi <br />- POULY EFFECTIVE <br />M1E(MEVDD/TYI POUCV E]fWiATxll/ <br />fNIE(AO.VDDVYI') - LDS <br />A GETT/ EML UA®ITTV 9 1- 3 1 1 0 0 0 1 8 1/ 2 0/ 9 6 )/ 2 O/ 9] GENERAL AGGREGATE E 2 0 0 0 O O O <br /> X COMMEACIpL GENERAL LIAe1LnY PRODUCTSCOMPIOP AGG E D D D D D <br /> CL41M5 ~ OCCUR <br />% PERSONALb ADVIWURV f <br /> MADE <br />OWNER'Sb CONT PROT EACH OCCURRENCE i 1 Q D D D D D <br /> _ FIRE DAMAGE (Anyone fre) f <br /> MED E%P IAny one parson) E 1 D D D D <br /> AUR1Eg0EE UARRITY <br /> COMBINED SINGLE LIMB f <br /> ANY AUTO <br /> _ <br /> ALL OWNED AUTOS BODILY INJURY E <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br />NON~OWNED AUTO BODILY 1 W URV <br />IPer eccldenll <br />E <br /> PROPERTY DAMAGE f <br /> <br /> (JJTAGE LMBMY AUTO ONLV~EA ACCIDENT E <br /> ANV AUTO OiNER THAN AUTO ONLY: <br /> EACH ACCIDENT f <br /> AGGREGATE E <br /> E7fCE55 LNBR1IY EACH OCCURRENCE E <br />_ ___ UMBRELLA FORM _ _ _ __ _ _ <br />^ _ _ AGGREGATE E <br /> OTHER THAN UMBRELLA FORM <br /> Y/OIEOAANS COMPFl151H10N AND <br />EA~IDYHrS WI®JTY STATUTOM UNITS E <br /> <br /> EACH ACCIDENT E <br /> THE PROPRIETOW ^ INCL <br />PARTNERS <br />NE <br />E <br />E DISEASE-POLICY LIMIT <br />f <br /> I <br />% <br />CUI <br />OFFICERS ARE: E%CL DISFJISE-EACH EMPLOYEE f <br /> OTHER <br />DESCRIPTKXI6OPETiR710NS~lf]('ATgNSlVE7WEg5PECNL IIF]AS <br />i NSURER HILL NOTIFY DIVISION WHENEVER SUBSTANTIVE CHANGES ARE MADE IN <br />THE POLICY INCLUDING ANY TERMINATION OR FAILURE TO RENEH. THIS POLICY <br />APPLIES TO PERMIT kC-81-010 AND INCLUDES COVERAGE FOR PROPERTY DAMAGE <br />CEHtTFTCATE FHDLDEA <br /> SIbUID ANY OF THE A®VE DES PIX1Lg3 ~ CANCHIID ~01iE THE <br />COLORADO DEPT O F NATURAL RESOURCE 5 E]~IRATTON DATe THET€OF, tHE ISSUING COMPANY wal(~~ MAIL <br />DIVISION O F MINERALS b GEOLOGY 1 0 aYS vyTarTFTI NDTI~ ro TIC CFATIFIGTE HOIDFJi NAMED roTl~lFFf <br />215 CENTENNIAL BUILDING ~~~~ ~~ <br />1313 SHERMAN STREET <br />1\3f~Pl(1P9lIXK9P1PN9(~(9(~k9PM#X11(9~)E~P1l)pM7~Fi(aB~p!(~1lit"?c9(XXXXX <br />DENVER , c o 8 0 2 0 3 <br /> ~ <br /> I,// ( <br />_ _ -- .. - _ _ . - _ . _ - . -_ - _ -_ - - <br />2 - 2 2 <br />ACORD 25-5 3RJ3 ~~ CARPOFIATION 1980 <br />