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GENERAL37514
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GENERAL37514
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Entry Properties
Last modified
8/24/2016 7:57:36 PM
Creation date
11/23/2007 9:12:35 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1996084
IBM Index Class Name
General Documents
Doc Date
9/13/2002
Doc Name
Certificate of Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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I Marsh USA Inc. 9/13/02 11:2 6 PA(}E 2/2 RightFAH <br />r„ <br />'"-,: .-:': .. '°"- ,...' <br />"" .. o ..,. ~, <br />- .:: , ,,, - CERTIFICATE NUMBER <br />` <br />. <br />;~ ,: - __F ..._ ....., .w. <br />-'- :.._~ > <br />ATL,aoo7lasas-oo <br />~ <br />PRODUCER 7X18 CERTFICATE NI 188UEp 49 AMATTER OF INFORMATION <br />ONLY ANb CONFERS <br />Mesh NO RNiHTB UPON 7HE CERTIFICATfi HOLDER OTHER THAN THOSE PROVIDED W THE <br />P.O. BO% 38012 POLICY. TI118 CE RTFICATE OOEB NOT AMEND, EXTEND OR 1LL7ER THE COVERAGE <br />Kn0%Ne, TN 3793-6Q12 AFFOROE06Y THE POLIC~80ESCRIBEO HEREIN. <br /> COMPANIES APPORDINO COVERAGE <br /> COMPANY <br />00004- A STEADFASTINSURANCE CGM PANY <br />W9URE0 CQAPNVr <br />LORENCITO COAL COMPANY, LLC B NIA <br />20500 Hir$Iway 12 <br />Weston, L`O 81091 <br />ca-nPavv <br /> C NIA <br /> camPAVr <br /> D N/A <br /> <br />THIS IS TO CERTIFY THAT P0.10ES OF INSIRPNCE DESCRI9E0 HERBN HAVE BEEN ISSUED TO THE INSIRED NMAED HEREIN FOR THE PQICY PERIOD INDICATED. <br />NOTlMTHSTANDlNG ANVREQUIREMENT, TERM OR CQV01770N OF ANV CONTRACT OR OTHER DOCUMENT N1TH RESPECT TO WHICH THE C8ITIFICATE MAY BE 1591ED OR MAY <br />PERTNN, 7HE IN8IRANCE AFFORDED BY THE POUQES DESCRIBED HERBN 139UBJECT TO ALL THE TERM$ COJDITIOVS AND E%LLU9IXJ3 ff Sld POLIOES LIMITS 910VAV <br />MAV HAVE EEEN REDUCED aV PND 0.NM9 I <br />CO TYPE OF INSURANCE POLICY NUM9ER POLICY EFFECTNE POLICY EXPIRATION LIMArB <br />LTR OA7E QANIDDIYY) GATE QAMIODIYY) <br />A GE NERAL Uasaln BOG 9304453 08f13/02 08H 3103 <br />GENERAL AGGREGATE 000,000 <br />$ 2, <br /> J( COMMERCI N_GENERAL LIABILITY PRODUCra-GONP/OP AGO $ 1,0001000 <br /> 0.NM8MADE OOCCUR PERSONAL 8AOVINJURY $ 1,000,000 <br /> Q"MER'38 CQJTRALTOR'3PROT EACH OCCURRENCE $ 1,000,000 <br /> FIRE DAMAGE(MymeAre) $ 50,000 <br /> MED E7fP M me Mem $ 5,000 <br /> /WT OM OBOE LIABILITY <br /> CCMBINE09NGLE LIMIT $ <br /> AVY NITO <br /> ALL ONNED AUT09 aODILYINAIRV $ <br /> (Pm PCB) <br /> SCHEDULED AUTOS <br /> HIRED AUTOS SODILYIN,URY $ <br /> CPa a<d11mU <br /> NOV-OVrNED AUTOS <br /> PROPERTY DAN AGE $ <br /> <br /> GARA[AE LUU11lITY <br />NITOONLV-EAACOOENT <br />$ <br /> ` <br />~~~~ <br /> /NV N1T0 OTHER THAN AUTOIXJLV `.~%.~tw <br />S+__~ c. <br /> EAC,I ACLIDENT $ <br /> AGGREGATE $ <br /> E%CE99 LUUIIUTV EACH OCCURRENC^c $ <br /> UMSRELLAFQRM AOOREOAIE $ <br /> OTHER h1AN UMBRELLA FORM $ <br /> ENPLOYERB'LUVIILRY T6iV LIMITe ER <br />-~ <br /> EL EACH ACCIDENT $ <br /> THE PROPRIETOR/ <br />' IN0. EL DIScASE7QICY LIMIT $ <br /> PAR7NER3 <br />E7EQITIVE <br />OFFI0329 ME: <br />IX0. <br />EL DIB=A>gEALH EMPLOYEE <br />$ <br /> <br />OEBCRMTION aF W ERATN)NBILOCATONBIVENICLE818PECUY.ITEM 8 a1M178 MAY BE eU3JE CT TO OEOUCTIBLEe OR RETENTIONS) <br />RE: Permits CAB-084 <br />Location: 2 Miles West of Segundo, CO on Highway 12 <br />Deductible: $5,000 Combined BI 8 PD Per Owlmence <br /> SH01p0 ANY OF TIE POLIOE9 OE9OLI9Ep IEREIN BE GNOiLEO BEFORE TIE EXPIRATION PATE iHERE6. <br /> lIE INSAEq AFFOIpING COVEM(! YRLL E MNL _~p pAY9 VIRITTEN NOTIQ TO TIE <br />Colorado Division of Minerals 8 Geology plpTPIGT! 1 <br />0ER IApEO IERII <br /> <br />1313 Sherman Street 10. <br />N <br />Denver, CO 80203 <br /> ARBH U8A WG <br /> v: Samuel F. Robimm~ <br />
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