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GENERAL37527
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Entry Properties
Last modified
8/24/2016 7:57:37 PM
Creation date
11/23/2007 9:12:49 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981014
IBM Index Class Name
General Documents
Doc Date
9/3/1981
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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cXOrd ~ ~;_~:~ <br />' ~. "_ .. <br />NAME AND ADDRESS OF AGENCY <br />MOL&RICHARDSON CO. <br />311 W. 3RD STREET <br />PALISADE, GO BIb26 <br />TEL: (303) 464-6661 <br />E MID ADDRESS OF INSURED <br />Dorchester Coal Co. <br />2795 Skyline Court <br />Grand Junction, CO 81501 <br />of ony contract or <br />terms. exclusions <br />DATE <br />COAT: <br />hereon is subject to all the <br /> Limits of Lla IIITy R Thousan s ~ <br />COhIPANY <br />LETTER TYPE OF INSURANCE POLICY NUMBER POLICY <br />E%PIRATION DATE EACH AGGREGATE <br /> OCCURRENCE <br /> GENFRAL LIABILITY <br /> BODILY INJURY f f <br />A ®COMPREHENSIVE FORM 583JK7536 6/30/82 <br /> <br /> ^ PREMISES-0PERATIONS PROPEREV DAMAGE f f <br /> ^ E%PLOSION ANJ COLLAPSE <br /> HAZARD <br /> ^ UNDERGROUND HAZARD <br /> ^ PRODUCTS/COMPLETED <br /> OPERATIONS HAZARD BODILY INJURY AND <br /> ^ CONTRACTUAL INSURANCE PROPERTY DAMAGE f 500 f 500 <br /> ^ BROAD FORM PROPERTY COA181NED <br /> DAMAGE <br />^ INDEPENOFNi CONTRACTORS <br /> ^ PERSONAL INJURY PERSONAL IN JURY f 500 <br /> AUTOMOBILE LIABLE BODILY INIURY <br />f <br /> (EACH PERSON) <br /> ^ COMPREHEN FORM BODILY INJURY f <br /> ^ (EACH ACCIDENT) <br /> OWN <br /> PgpPERTY DAMAGE f <br /> IRED <br /> BODILY DIJURY AND <br /> NON-0WNCD PROPERTY DAMAGE f <br />~ COMBINED <br /> Excess u <br /> BDDILY INJURY AND <br /> ^ U ELIA FORM PROPERTY DAMAGE f f <br /> OTHER THAN UMBRELLA COMBINED <br /> FORM <br /> WORK OMPENSATION sTATUroRr <br /> and <br /> EMPLO S' LIABILITY f <br />If YX 4CCiDFNi1 <br /> OTHER <br /> 1 ~I1~~ <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES <br />Coal Mining <br />Cancellation: Should any of the above descrt~~d policies be cancelled before the expiration date thereof, the issuing com- <br />pany will endeavor to mail -days written notice to the below named certificate holder, but failure to <br />mail such notice shall impose no obligation or liability of any kind upon the company. <br />NAME AND ADDRCSS OF CERTIFICATE HOLDER <br />Carol C. Russell <br />Mined Land Reclamation <br />423 Centennial Building <br />1313 Sherman Street <br />coMPAnY <br />LETTER IrrdN~ (~~pne~(~M <br />COMPANY ~ GOLOi ~~ "-y <br />LETTER <br />I the Insured named above and are in force at this dme. Notwithstanding <br />moy be issued or may pertain, the insurance afforded by tho policies E <br />COMPANIES AFFORDING COVERAGES <br />COMPANY <br />LETTER A Paul <br />St <br /> . <br />COMPANY <br />LETTER <br />°nE <br />"' ~ 981 <br />R SEP 0 3 1 <br />iii iiiiiiiiuiii iii <br />MICHAEL C. KNODE <br />ACORD 25 (1-19) <br />
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