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n e CERTIFICATE OF INSURANCE -WORKMEN'S COMPENSATION & LIABILI'iY ONLY This certificate is issued as a matter of information only arld confers no rights upon the certificate holder. Tl+is certificate does not amend, extend or alter the coverage afforded by the policies listed below, Job No. 5112 Project Permit for Grassy Gan Coal Mining Location Routt County ('.olnrarin owner Colorado Department of Natural Resources. Mined Land Reclamation Division, 1313 Conuacto, Sherman St.. Denver. CO 80203 __ _ Architect/Engineer Insured Rvan Incorporated Central; Ryan Incorporate of Wisc.. P.0. Box 206. Janesville. WI 53 Agent Cobb, Strecker, Dunphy & Zimmermann, Inc. Address~02 International Lane, Madison. WI WORKMEN'S COMPENSATION: pnlTy No W 0 3 88 Effective 9/30/86. Expiration 9/30/87 Insurance Company Transportation Insurance Comoany Address Milwaukee. Wisconsin Coverage-Workmen's Compensation, Statutory. Employer's Liability Limit S 1,000,000./81,000,000./ each accident 547 53704 PUBLIC LIABILITY: 1,000,000. Poling No CCP~O 024 31 78 Effective 9/30/86 Expiration 9/30/87 -InsuranceCompeny Transportation ~Insur--ante Company -Address Milwaukee.-Wi~scon5-in --- ~ - Type of Policy: ®Comprehensive ^Other LIMITS: Bodily Injury S Each Occurrence Property Damage S Each Occurrence S Aggregate Personal Injury S Aggregate COVERAGE PROVIDED (Check Applicable Square!: $ Aggregate -OR - Combined Single Limit $ 1 •000.000. Each Occurrence Yes No Yes No Operations of Contractor ® ^ Governmental Immunity is waived ^ Operations of Sub•Contractor (cantingentl ® ^ Property Damage liability includes: Does Personal Injury include claims Damage due to blasting © ^ related to employment? © ^ Damage due to collapse ® ^ Completed Operations/Produeti ~ ^ Damage to underground facilities ® ^ Contractual Liability (broad form) ® ^ Broad Form Property damage ® ^ Exceptions: AUTOMOBILE LIABILITY: Policy No. 31 79 Effective 9/30/86 _ Expiration 9/30/87 Insurance Company Transportation Insurance Company gddress Milwaukee. Wisconsin Type of Policy: ®Comprehensive ^Other LIMITS: Bodily Injury: $ Eaeh Person - OR - $ Each Occurrence Combined Single Limit $ 1.000,000. Each Occurrence Property Damage $ Each Occurrence Yes Na Coverage is provided for operation of all owned, hired and non owned vehicles ® ^ Policy No._UMtl 3U 044 "l6 84 Effective 9/30/86 Expiration 9/30!87 Insurance Company Continental Casualty CDmodn.y Address Ch7CdQ0. 1111 n0'Is LIMITS: Single Limit Bodily Injury and Property Oamage $. 1, 0001000. Each Occurrence Yes No COVERAGE PROVIDED: Applies in execs: of the coverages listed above for Enployer's Liability. Public Liability and Automobile Liability SUBJECT TO THE TERMS OF THE POLICY. ® ^ Are any deductibles applicable to bodily injury or property damage on any of the above coverage:? II so, list. ^ AGENT CARRIES ERRORS AND OMISSIONS INSURANCE ® ^ Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail !i/teen days written notice r0 the 0rerdtKNl7710tl(certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, a Dated at Madison, Wisconsin on 12/16/86 By ~w~ We WW/Li/1+'~r uthori red Insurance Representative Con,truclion Intlu,rry Cooperalivs Comm111ee of Minnerora -Form C.I.C.C.~70I, Feb. 1961, Rev. June 1969, Rev. Jan. 1971, Rev. Nov. 1977 Printed by H. A. Rogers Co., 7JZ0 Wayxara Olvd., Mpls.. 55405, 077~4a70