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GENERAL38003
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GENERAL38003
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Entry Properties
Last modified
8/24/2016 7:57:56 PM
Creation date
11/23/2007 9:25:40 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981024
IBM Index Class Name
General Documents
Doc Date
6/8/1998
Doc Name
CERTIFICATE OF LIABILITY INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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iii iiiiiiiiiiiiiiii _ __ _ <br />i COD CERTIFICATE OF LIABILITY INSURANCE mini woQ FMT <br />I PRODUCER , , , THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />oEi6:.ICK DF CALIFOkNIA. IPlC. ~ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />r'.T I IJ: ! F.UMA •JUi INSCIN Hot nFw THIR CFRTIFICATF HOES NOT AMFMn FYTFNn OR <br />/01 5. PARKER ST. SUTTE 5000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW-.-~ <br />iIRP,iVGE, C.A 92C-~68-47:!J __ __ COMPANIES AFFORDING COVERAGE _ I <br />__- ____ -' <br />l14-7P J_/ROD I <br />COMPANY <br />_ __ __ --- --- -.. A UNDUE WRITEP,S IN;=UBflNCE~O_ <br />INSURED COMPANY <br />i <br />B COtltlERCSAL SJNDFRbJRIIER3.11113. -~ <br />ISAI~FI4 VENTURF_Sr INC COMPANY ~ <br />. <br />3633 c. INLAND c19PIRE BL.. <br />#850 -_ <br />C i <br />CTIJTAkJO. Cf. 9;76 4 copANV <br /> <br />COVERAGES I <br />~ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES._LIMITS_ SHOWN_ MAY HAVE BEEN REDUCED BV PAID_CLAIM__S._ _ _ _ _ _ _ _ __ __ _ <br />` <br />POLICY EFFECTIVE I POLICY E%PIRATION UMO9 <br />CO TYPE OF INSURANCE POLICY NUMBEN <br />LTR DATE (MM/ODN1T DATE (MM/OON1T i <br />rj OENEPAL WBIUTY SRGOO2~43 6/01/96 6/01/99 -GENERAL AGGREGATE f iJ'iOO~1il <br />K COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG f l O{LQ: ;~'(lO <br />'. CLAIMS MADE '/ OCCUR PEFSONALAADV INJURY _ f 1~QOO_r.,OL~ <br />OWNER'SA CONTPACTOR'S PROT EACH OCCURRENCE _f 1r_QS]-f~~Y <br />^ <br />i FIREOHMAGE(Anyonennl S 'j(]~ QQO <br />' MED EXP (AnY one pernpn) S ~ ' <br />AUTOMOBILE LIABILITY ' <br /> COMBINED SINGLE UNIT . S <br />ANY AUTO <br />I ALLOWNEDAUTOS RECEIVED <br />_ BODILY INJURY S <br />~~ SCHEDULED AUTOS (Per perwn) <br />~ <br />HIRED AUTOS ~' 1 ~ O Q A(I (IQ BODILY INJURY <br />S <br />V7 v <br />NON~OWNED AUTOS IJJV ~, (Per pcdtlanU T - <br />Division of Minerals dl GeDI09Y pgppERTY DAMAGE S <br />I <br />I <br />OARAOE UABRITY AUTO ONLY ~ EA ACCIDENT f <br />ANY AUTO OTHER THAN AUTO ONLY <br /> EACH ACCIDENT S <br /> AGGREGATE f <br />I ~ E%CESS LIABILITY SR UOO2R~1 6/01/98 6/01/99 EACH OCCURRENCE S10r pOO~ QO <br />I '1 UMBRELLA FORM AGGREGATE S1 Or OOO• 'JOO~ <br />OTHER THAN UMBRELU FORM f <br />WORKERS COMPENSATION AND ~ ~ WC STATU- OTH~ <br />TORY LIMITS ER _ I <br />EMPLOYERS' LIABILITY _ <br /> EL EACH ACCIDENT f <br /> <br />THE PROPRIETOR/ ~ INCL <br />PARTNEfU^/E%ECUTIVE ~ __ _ <br />EL DISEASE ~ POUCY UMIT S <br />- - - ~ - ~ - --- - - <br />OFFICERS ARE: EXCL <br />~ EL DISEASE ~ EA EMPLOYEE S <br />OTHER <br />DESCRIPTION OF OPEfiATIONf/LOCATIONSNEHICLES/SPECIAL ITEMS <br />RE: COLORF'.DO COAL I`tINE ~ WALSE NBERG tPERMIT N0. C-81-Q24) <br />i <br />~ CERTIFICATE HOLDER <br />CANCELLATION <br />I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />37~:TE: DF CDL DRADD ~ E%PIRATION GATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />DEPT. OF NATURAL RESOURCES _7(1 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT. <br />~ i 313 SHERMF:N STREET BUT FAILURE TO MAIL SUCH NOTCE SHALL IMPOSE NO OBUOATON OR WBNTY <br />DEi`IVER, CD 00203 OF ANY HIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATVES. <br /> AUTH0~12BOREPRESEl~UIJY <br />CC <br />// <br />, <br /> <br />ACORD 25S (1/95) ~ <br />~\// <br />'~3- 27 `~/~{~{ <br />~ <br />®ACORD CORPORATION 1988 <br />CERiSS_1 <br />
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