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GENERAL38751
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Entry Properties
Last modified
8/24/2016 7:58:24 PM
Creation date
11/23/2007 9:49:17 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1984063
IBM Index Class Name
General Documents
Doc Date
10/29/2004
Doc Name
Certificate of Insurance
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID L DATE IMM/DD/YYYV) <br />ABRAXPl 10 26 04 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />EnRisk Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />6100 Western Place, Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Fort Worth TX 76107 <br />Phone: 617-877-1684 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: St. Paul surplus I.inae Ina. <br /> <br />Ab INSURER S: <br />raxas Petroleum Corporation <br />Ms . Carol O'Brien INSURER C: <br />P.Q. SOX 7OlOO7 INSURER D: <br />San Antonio <br />TX 78270-1007 <br />, INSURER E: <br />GUVENAGES <br />n~, <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ADOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING S eulogy <br />ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH 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 ANO CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MM/DDM' LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br />A X X COMMERCIAL GENERALLIABILITV MU055334861 09/01/04 09/01/05 PREMiSES(Eaoccurencw) $ 100,000 <br />-- 'COOMSAIAIIE-~-000U = -- MED.EXP(Arry onw parcon)_ ` ..5.,,000 <br /> PERSONALBADV INJURY $ 5,000, OOO <br /> GENERAL AGGREGATE E 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIEB PER: PRODUCTS-COMP/OP AGG S 1,000,000 <br /> X POLICY PRO <br />JECT LOC <br /> AU TOMOBILE LUIBILITV <br />COMBINED SINGLE LIMIT <br /> <br />ANY AUTO <br />(Ea eccitlenl) $ <br /> ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Per person) $ <br /> HIRED AUTOS <br />BODILY INJURY <br /> <br />NON-OWNED AUTOS <br />(Per accident) $ <br /> PROPERTY DAMAGE <br /> <br />(Per accitlent) $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> 5 <br /> DEDUCTIBLE $ <br /> RETENTION $ S <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br />e.. FACOIDFNr - <br />$ <br /> ANYPROPitETOPIPFRTNERIEXECUTN <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE -EA EMPLOYEE $ <br /> If yes, desuibe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE-POLICY LIMIT <br />$ <br /> OTHER <br />DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />Certificate Holder included as Additional Insured and Waiver of Subrogation <br />provided as required by written contract, but only to the extent of such <br />contract and only for operations performed by or for the Named Insured. It <br />is warranted that no coal mining operations are being conducted by the <br />insured. RE: The Eastside Mine-CDMG Permit No. C-1984-063 <br />CERTIFICATE HOLDER CANCELLATION <br />Division of Minerals & Geology <br />Attn: Mr. Byron Walker <br />1313 Sherman Street <br />Denver, CO 80203 <br /> <br />DIVISIO SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ~FQ MAIL 3O DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />ACORD <br />
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