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GENERAL37874
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GENERAL37874
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Entry Properties
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 10-1-91 mj t <br />(This Certificate of Insurance neither affirmatively nor negatively <br />amends, extends or altars the coverage, limits, terms or conditions <br />of the policies it certificates.) <br />This is to Certify to <br />CIGNA Property and Casualty Companies <br />REVISED <br />Colorado Mined Land Reclamation Division <br />Room #215, Centennial Bldg. <br />1313 Sherlaan Street <br />Denver, CO 80203 <br />LAttn: Matthew Hayes <br />that the following described policy or policies, issued by The Company as coded below, <br />providing insurance only for hazards checked by "X" belcw, have been issued to: <br />NAME Atlantic Richfield Company, its Subsidiaries and subsidiaries <br />ADORess thereof as now or hereinafter constituted, Atlantic Richfield <br />of Plaza, 515 South Flower Street, Los Angeles, CA 90071 <br />INSURED <br />covering in accortlance with the terms thereof, at the following locationlsl: <br />Including Mountain Coal Company <br /> COMPANY CODES <br /> 2^CIGNAINSURANCE COMPANY <br /> 3^ CIGNA INS CO. OF TEXAS <br /> 5^ PACIFIC EMPLOYERS INS. CO <br /> g INSURANCE COMPANY <br />^ <br />J OF NORTH AMERICA <br /> ^A CIGNAINS CO OF ILLINOIS <br /> 6^ CIGNA INS. CO. OF OHIO <br /> ^IOTHER,-SPECIFYI <br /> FOLD <br />TYPE OF POLICY rw,nROS w.oOOE POLICY NUMBER POLICY PER100 LIMITS OF LIABILITY <br />(al Standard Workmen's statutory w. c. <br />Compensation & ~ ~ $ One Accident and <br />Employers' Liability Aggregate Disease <br />(b) General Liability <br />Premises-Operations (including "In~ <br />" ® ® SL GI D1-01-9D t0 S *See Each Person <br />eidental Contracts <br />as tlefined below) <br /> 77856-6 01-01-93 Below ^ Accident <br /> <br />'c Independent Contractors <br />~ ® ® S Each <br />^ Occurrence <br /> <br />°o Completed Operations/Products <br />m <br />Contractual, ISpecific type as <br />® <br />~ Aggregate--Completed <br />described in footnote below) _ _ _ _ _ _ _ _-_ _ - _ _S _ _ _ _ Operations/Products <br />Premises-Operations (Including ^ Accident <br />"Incidental Contracts" as defined <br />~ belowl <br />® <br />® <br />SL G1 <br />01-01-90 t0 Each <br />S *See ^ Occurrence <br />4 77856-6 OI-Ol-93 Below <br />O Independent Contractors ® ® E Aggregate-Prem./Oper. <br />u <br />° S Aggregate-Protective <br />o <br />Completed Operations/Products ® ® S Aggregate~ompletetl <br />n <br />Conlretlual, (Specific type as <br /> <br />® <br /> <br />® Operations/Products <br />destr~bed in footnote belowl $ Aggregate-Contractual <br />Ic- Automohile Liability <br />OwR@rf7Cuiomotides ^ ~ S Each Person <br />~~ <br />~ Hired Automobiles <br />8'c <br />ea ^ Accitlenl <br />Each <br />~ <br />~ <br />=Nonowned Automobiles _ - - _ _ _ _ _ _ _ _ _ _ _ _ ^ Occurrence <br />S- _ _ _ _ _ <br />la <br />w ~{ Owned Automobiles <br /> <br />° <br />~ ^ Accident <br />Each <br />q Hued Automobiles <br />oo S ^ Occurrence <br />a0 Nonowned Automobiles <br />(d) , , ine Sing <br /> Limit per occurrence/ <br /> Aggregate where applicable. <br />Contractual Footnote: Subject to all the policy terms applicable, specific contractual <br />coverage ~s prowdetl as respects It is the intention of the company that .n the event of cancellation of <br />Cheek ~^ a contract 1 the polity pr policies by the company, ten 110) days' written notice <br />Applir~ble ^ purchase order agreements l1 between the Insured and: of such cancellation will be gwen to you at the adtlress stated above. <br />Block ^ all contracts <br />E OF OTHER PART V <br />Definitions: "Incidental contract" means any wr~I ten 111 lease of premises 121 easement agreement, except in connection with construction or tlem Olil~On Op¢ra- <br />nons on or adjacent to a railroad, 131 undertaking to indemnify a municipality requ~r nicipal ord~nan e, except' connection with work for <br />the municipality, 141 sidetrack agreement, or 151 elevator main tenance agreement. <br />uthorizetl Representative <br />LC-13fige Pld. in U S A <br />1.ORIGINAL <br />
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