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GENERAL37875
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Entry Properties
Last modified
8/24/2016 7:57:51 PM
Creation date
11/23/2007 9:22:20 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1984065
IBM Index Class Name
General Documents
Doc Date
7/8/2004
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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acoRV CERTIFICATE OF LIABI LITY INSURANCE GP ID P DATE (MM/DD/YY) <br /> CIGF-1 07/02/04 <br />PROOUCeR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Blanchard Insurance Group Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 60130 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Grand Junction CO 81506 <br />~~O <br />~~® <br />Phone: 970-245-8011 Fax:970- INSURERS AFFORDING COVERAGE <br />INSURED <br />~,\(~oy INSURERA Empioyer5 Mutual Casualty Co. <br />O <br />c \~ LL~V INSURER B: <br />GaB\ <br />yy <br />C <br />~$aad <br />e <br />s INSURER C: <br />~aeta <br />8717 Del <br />any <br />AVenue #115 <br />ul <br />Pla <br />Re <br />CA 90293 <br />d <br />INSURER D: <br />`Sa <br />ya <br />y <br />e <br />V\S <br />Q\ INSURER E: <br />COVERAGES <br />THE PO! ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ~ <br />ANY REQUIREMENT, TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W ITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR TYPE OFINSURANCE POLICY NUMBER DATE MMIDD/YY DATE MM/DD/YY LIMITS <br /> GENERAL LIABILRY EACH OCCURRENCE $ SOD, OOO <br />A X COMMERCIAL GENERAL LIABILIN 1X152$6 D7/12/D4 D7/12/D5 FIRE DAMAGE (Any one fire) $ 1DD, DDD <br /> CLAIMS MADE ^X OCCUR MED EXP (Myone person) g 5,000 <br /> PERSONALS ADV INJURY $ SOD, DDD <br /> GENERAL AGGREGATE § 1, DDD, DDD <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E 1, DDD, DDD <br /> POLICY PRO- LOC <br />JECT <br /> AUT OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />§ <br /> ANY AUTO (Ee accitlenl) <br /> ALL OW NED AUTOS <br />BODILY INJURY <br />$ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br />BODILY INJURY <br />§ <br /> NON~OW NED AUTOS (Per ecmQenq <br /> PROPERTY DAMAGE <br /> <br />(Per accitlenp § <br /> GA{UIGE LIABILRY AUTO ONLY, EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC § <br /> AUTO ONLY: AGG § <br /> E%CESS LIABILITY EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE $ <br /> RETENTION E $ <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYER5 LIABILRY <br />_- __ _ _._ _ -~_ _ __ _ E.L.-EACH ACCIDENT-- $- <br /> E.L.OISEASE~EAEMPLOYE $ <br /> E.L. DISEASE-POLICY LIMIT § <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/E%CLUSIONS ADDED RY ENDORSEMENT/SPECIAL PROVISIONS <br />DMG Permit No. C-84-065 - Coal Ridge No. 1 Mine East of New Castle, CO <br />South of the River. NCIG Financial, Inc. and the State of Colorado Division <br />of Minerals & Geology are included as Additional Insureds. *10 Days Notice <br />For lion-Payment Of Premium **or incur substantive changes or failure to <br />renew. <br />lJLtt11Y1gA1C 11VLUC1/ N ADORIDNAL INSURED; INSURER LETTEN: GHIVgtLLX11VIV <br />DD DD DDD SHOULD ANY OFTNE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRATION <br />State of Colorado DATE THEREOF, THE ISSUING INSURER WILL>MAIL *30 DAYS WRITTEN <br />Division of Minerals & GElOlogy ~ NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, ~7bOML~HEIDZ®~CIDIAUIX <br />1313 Sherman Street, Room 215 »DlaN[lB~+ata7acB~v~oT-~ID:a9ma7tsiMgM&m~sSx~A~'snx <br />Denver CO 80203 rte. <br />ACORG 25-5 !7/971 <br />
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