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GENERAL37205
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Entry Properties
Last modified
8/24/2016 7:57:25 PM
Creation date
11/23/2007 9:02:17 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981008
IBM Index Class Name
General Documents
Doc Date
1/5/2005
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MM/DD/YYYY) <br />WESTE-1 12 30 04 <br />rC <br />PRODUCER ~ <br />~ ION <br />C <br />I <br />P <br />V <br />v v ON Y <br />AND <br />CONFERS NO RIGHTS UPON THE CERTI <br />ICATE <br />Hays Companies GGE~ <br />80 South 8th Street #700 R4 <br />~~ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Minneapolis MN 55402 9i~ ~.~ y <br />Phone:612-333-3323 Fax: 612-373-7 ~~~ <br />WILR]RER$AFFORDINGCGVERAGE NAIC# <br />INSURED ~~s~5 <br />n INSURER A: Chubb CUStOm Insurance Co. <br />\ <br />~M <br />O ~ <br />~ INSURER B: xiiinoie o~.o~ xnaunance co. <br />c. <br />Western Fuels Associatio~y@l <br /> <br />Attn: Nanc}[ Kelly INSURER C: <br /> <br />P. ~. $OX 33424 <br />Denv <br />CO 80233 _ _ _ <br />INSURER D: <br />er <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW ITMSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OFINSURANCE POLICY NUMBER GATE MM/DD TN PDATE MM/DD O LIMBS <br /> GENERAL LUVIILRY EACH OCCURRENCE $1,000,000 <br />A X COMMERCIAL GENERALLIABILITV 79545130 Ol/O1/OS 01/01/06 PREMISES (Eaocarence 850,000 <br /> CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 1 D , DDD <br /> `"` PERSONAL BADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIEB PER: PRODUCTS-COMP/OP AGG $2,000,000 <br /> POLICY JECT LOC Em $@n. 1,DDD OOO <br /> AUT OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br /> ANV AUTO <br />(Ea actitlenl) <br /> ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Per person) $ <br /> HIRED AUTOS <br />BODILY INJURY <br />$ <br /> NON-OW NE'.D AUTOB (Per aaident) <br /> PROPERTY DAMAGE <br /> <br />(Per acudenl) $ <br /> GARAGE LIgBILIITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXLESS/UMBRELLALVIBILITV EACH OCCURRENCE $20,000,000 <br />$ X occul>, ~cLAIMSMADE XOOG22082188 Ol/Ol/OS 01/01/06 AGGREGATE $20,000,000 <br /> a <br /> DEDUCTIBLE $ <br /> X RETENTION $SD,000 $ <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILRY <br /> ANY PROPRIEETO0R/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ <br />__ OFFICERIMEMBERFXI:LUDED?-- E.L. DISEASE~EA EMPLOYEE $ <br />~ If yes, describe antler - <br /> SPECIAL PROVISIONS below E.L. DISEASE ~ POLICY LIMIT $ <br /> OTHER <br />DESLRIPTK)N OF OPERATKINS / LOCATK)NS / VEHK:LES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Evidence of Insurance as respects <br />New Horizon Mine in Nucla, CO (Permit #C-61-008) <br />Includes use of Explosives <br />V CRI IrIVMIG ~1VLVCR <br />COLOR-2 SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />Colorado Mined Land DATETMEREOF,THEISSUINGINSURERWILLk~~~~MAIL 3O DAYSWRRTEN <br />Reclamation NOTICE TO THE CERTIFICATE HOLDERN EO TO THE LEFq(~Xp~s,7(jQ~(1`,d'~%VMJ(L <br />Mined Land Division <br />1313 Sherman Street, RM 215 X^k'RR)d1P)~R9(4(9I7FxR9(L~'@SF N RW~WKH;K94~KSSpX <br />Denver CO 80203 <br />ACORD 25 (2001108) <br />
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