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GENERAL37971
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GENERAL37971
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Last modified
8/24/2016 7:57:54 PM
Creation date
11/23/2007 9:25:03 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1984063
IBM Index Class Name
General Documents
Doc Date
1/7/2002
Doc Name
CERTIFICATE OF LIABILITY INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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KATE OF LIABILITY INSURANCE GP ID G GATE IMM/DD/YY) <br />ACL III IIIIIIIIIIIII III .... 7[BRAXPl 09/04/0: <br />PRODUCER THIS CERTIFICATE 1 iUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS Iv0 RIGHTS UPON THE CERTIFICATE <br />EnRisk Services, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 2624 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Fort Worth TX 76113-2624 <br />Phone: 817-877-1884 INSURERS AFFORDING COVERAGE <br />Abraxas Petroleum Corporation <br />Ms. Carol O'Brien <br />P.O. Hox 701007 <br />San Antonio TX 78270-1007 <br />INSURER A: St. Paul Surplus Lines Ina. <br />INSURER B: <br />INSURER C. <br />INSURER D: <br />INSURER E. <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR TYPE OFINSURANLE POLICY NUMBER DPTE MMI00/YY DATEVMMPDDfVY N LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY MDOSS31B O7 O9/O1/O1 O9/O1/02 FIRE DAMAGE (Any one fire) S 100,000 <br /> CLAIMS MADE ~ OCCUR MED EXP IAny one person) E $ , O O O <br /> PERSONALBADV INJURY S 1,000,000 <br /> - - - -- - - - - -- GENERAL AGGREGATE E 2,000,000 <br /> GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPIOP AGG S 1,000,000 <br /> X POLICY PRO- <br />JECT LOC <br /> AUT OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />E <br /> ANY ADTQ RECEIVE (Ea ac°°°"' <br /> ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />0 <br />(Per person) E <br /> JAN <br />7 200 <br /> HIRED AUTOS <br />BODILY INJURY <br /> <br />NON~O WNED AVTOS <br />(Per acnOenD S <br /> Division of Minerals an Geology <br />PROPERTY DAMAGE <br /> <br />IPer acnEenp S <br /> GA RAGE LIABILITY AUTO ONLY ~EA ACCIDENT E <br /> ANY AUTO OTHER THAN EA ACC S <br /> AUTO ONLY AGG E <br /> EXCESS LIABILITY EACH OCCURRENCE S <br /> OGGUR ^ CLAIMS MADE AGGREGATE E <br /> E <br /> DEDUCTIBLE S <br /> RETENTION S S <br /> WORKERS COMPENSATION AND <br />' TORY LIMITS ER <br /> EMPLOYERS <br />LIABILITY <br /> E L EACH ACCIDENT S <br />-- - -_ .. _ ._ _ _ _ E L DISEASE - EA EMPLOYEE E <br /> " - - ~ ~- -- <br /> E.L DISEASE -POLICY LIMIT E <br /> OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHILLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS <br />It is warranted that no coal mining operations are being conducted by the <br />assured. <br />4CRIITII,HLC l1VLUCR yN gDDITIOHAL INSURED; INSURER LETTER: l.A1Nl.CLLHIlU1V <br />DZVOFMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />DATE THEREOF, THE ISSUING INSURER WILL MAIL 34- DAYS WRITTEN <br />D1V1810n Of Minerals and NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Geology <br />Attn: Mr. Byron Walker <br />1313 Sherman Street <br />DenVBY CO aO2O3 AUTHORIZED REPRESENTATIVN,A <br />
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