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GENERAL37874
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GENERAL37874
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Last modified
8/24/2016 7:57:51 PM
Creation date
11/23/2007 9:22:19 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980007
IBM Index Class Name
General Documents
Doc Date
12/6/1989
Doc Name
Certificate of Insurance
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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CERTIFICATE OF INSURANCE 12/1/89 jb <br />This Certificate of Insurenee neither a}firmstivsly nor nagstively <br />amends, eXtends or attars the Coverage. limits, terms or conditions <br />Tf the policitn n certificates.) <br />This is to Certify to <br />rMined Land Reclamation Division <br />Department of Natural Resources <br />723 Centinnial Bldg. <br />1313 Sherman Street <br />Denver CO 80203 <br />t-IVnn nopeny ana ~asuony ~ompanles <br />COMPANY CODES _._ <br />©CIGNA INSURANCE COMPANY <br />© CIGNA INS. CO OF TEW+S <br />L ' <br />lust the lotlowing described pol,cy or policies. ,slued by The Company as coded below, <br />orov,d,ng insurance only for hatartls checked by "X" belcw, have been ,slued to: <br />NAME Atlantic Richfield Company, its Subsidiaries and subsidiaries <br />ADDRESS thereof as now or hereinafter constituted, Atlantic Richfield <br />INSURED Plaza, 515 So. Flower Street, Los Angeles, CA 90071 <br />covering in actortlantt with the terms thereof, at the following IOCal,onlsl: <br />d PACIFIC EMPLOYERS INS CO. <br />g INSURANCE COMPANY <br />J ^ OF NORTH AMERICA <br />0 CIGNA INS. CO. OF ILLINOIS <br />© CIGNA INS. CO OF OHIO <br />^ IOTHER,-SPECIFY) FOLD <br />TYPE OF POLICY l7D. CODE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY <br />(al Standard Workmen's statutory w. c. <br />Compensation 8 ~ ~ $ One Acc,dent ana <br />Employers' Liability Aggregate Disease <br />Ih) General Liability <br />I Premaes-Operations land udmg "In- <br />" i~ <br />L~ <br />151+ (il <br />01-01-90 t0 <br />f *See Each Person <br />cadence) Contracts <br />as definetl below) <br />> ( ^ Acutlent <br />~ <br />'c Independent Contractors <br />® <br />~ <br />077856-6 <br />01-01-93 Each <br />S Below ~ ^ Occurrence <br /> <br />o Completed OperahOns/Products <br />m <br />Contractual, (Specilit type as <br />described ,n footnote below) _ _ _ <br />-~ _ <br />~- <br />_ _ - _- <br />_ -_ - - _ Aggregate--Completed <br />S _ - _ _ Operanons/Products <br />Premises-Operations (lntluding ^ Accident <br />"Incidental Contracts"es defined ~ ~ Each <br />^ O <br />S <br />below) <br />E ISL G1 01-01-90 to ccurrence <br />yr <br />See <br /> <br />A <br />O Independent Contractors <br />077$56-6 <br />01-01-93 <br />S Below Aggregate-Prem./Oper. <br />>- <br />i ~I <br />~ S Aggregate-Protective <br />Completed Operations/Products L~ $ S Aggregate-Completed <br />a <br />Contractual, (Specific cups as Operations/Products <br />tlescribed in footnote below) S Aggregate-Contractual <br />11:) Automobile Liability <br />Owned Automobiles <br />a???---III <br />ISA 001903 <br />Ol-Ol-90 to <br /> <br />Ol-Ol-93 <br />) S See Each Person <br /> <br />Below <br />} <br />,l H <br />ed A <br />tomobil ^ <br />o, <br />ir <br />u <br />es <br />t <br />m ) <br />Accident <br />Each { <br />=Nono_wned Automobiles _ - _ _ _ - _ _ - _ _ - - _ S- _ - _ <br />^ Occurrence_ <br />'" ISA 001903 Ol-Ol-90 to l *See <br />Owned Automobiles <br />Ol-Ol-93 ^ Atttdent <br />Below Eatn <br />oo°A Hired Automobiles ~ ^ Otturrente <br />s <br />rs O Non owned Automobiles <br />(d) •$2,000,000 Com fined Single Limit per occurrence <br /> subject to egg gate of $2,000,000. where applicable. <br />~ontrae[ual Footnote: Subject to all the Ool,cy terms apDlitable, sPecrl it contractual <br />coverage ,s provided as respects It is the intention of the Company that ,n the event of cancellation of <br />/ Cheek 1^ a contract the policy or policies by the company, ten 110) tlays' written notice <br />'Applinbl~^ purchase Ortler agreements between the Insuretl antl' of such cancellation will be given to you at the address stated above. <br />Block /^ all contracts <br /> NAME OF OTHER PARTY DATE (it apgncable) CONTRACT NO. lit any) <br />I V,V (V F[ JVtl) <br />De/initions. "Incdental contract" means any wrrtl¢n (11 lease of premises (21 easement agreement, exce m con netlion with COOStr ucnpn or tlemphbpn gPerd- <br />tions on or atllacenl [o a rauroa4 171 untlenaking to indemnity a mun¢ipalrty regwred by niU ordinyr~e exce tin connection wnh work for <br />the mumupalily, 141 utle vack agreement, or I51 elevator mam tenants agreement r`~'r` <br />Author,:etl Representai we <br />-G 138ge Pltl. in U S A <br />..c. ., <br />
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