My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
GENERAL39301
DRMS
>
Back File Migration
>
General Documents
>
GENERAL39301
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/24/2016 7:58:47 PM
Creation date
11/23/2007 10:05:34 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1991078
IBM Index Class Name
General Documents
Doc Date
8/26/2005
Doc Name
Certificate Insurance E-mail
From
Jim Stover
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
4
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
V L1, IX JULLIY.'tIiJ 3JJLJ: J <br />E IIV.~V I: f .:GIY:NYYW:IIQ <br />:VVV( J-IVN,I•IC <br />v" <br />" <br />~' <br />/~1 <br />~V7NC <br />d~ <br />~' <br />~ <br />.~ v P~ A n ~ r vv rEI"NY~rN G P nrrv DELTCOl 06 10 O5 <br />M~RODUCM TH18 CERTIFICATfi M IE8M60 A8 A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGFITB UPON THE CERTIFICATE <br />Synaxis Polk 6 Sullivan HOLDER THIS CERTIFICATE DOES NOT AM6Nb, EXTEND OR <br />3401 Noat &nd Ava. 8t~. 600 ALTERTNECOVERAGEAFFORDEDBYTH6POLICIESBELOW. <br />Naahvillo TN 37203 <br />$hOAe: 615-3@6-2860 FJlX: 615-385-8358 IN9l1RER9 AFFORDING COVERAGE NAICA <br />INSURED INSURERA csvvµ~sv x~xo Co. et cr <br /> INSURER <br />A0 <br />/IO <br />Od CpJf1 <br />COD <br />IPAn y <br />HA <br />Qg <br />yy <br />qq WBURER C: <br />~ <br />q~ <br />S8 <br />Qg <br />5 <br />NC <br />7 <br />B <br />a <br />aa <br />, <br />NnBhVilla <br />TN <br />37205 WBURER D: <br /> RBURER E: <br />COVERAG6B <br />TXB POLICIEb OF NbURANCE LIETED BELOW HAVE BEEN URSUEO TO THE IN9URED NAMED ABOVE FOR THE POLICY PERIDO INDICATED. NOTWRHRTANDWO <br />ANY REgUHiEMENT TERM DRCONORTON OF ANY CONTAA07 OA OTHER DOCUMENTWJOI RE8P8C7T0 WHICH THIS CERTA"lCATE MAY BE fSEUED OR <br />fMY PERTAIN, TXE INSURANCfi AFFORDED BY THE POLICIES GESCRIBfiO NfiREW 19 SUBJECT TO ALL TXE TERMS, E%CLU810N8 AND CONOITONB OF BDCM <br />POLICES. AOORERATE LIMR89NOWN MAY HAVE BEFN REDUCED BY PAID C WMB. <br />LTR INeRO TYP80F INWRINCB POUCY NUMBER GATE M DATE YMAI LLWTG ' <br /> O[NCRAL LMENJTY EACH OCCURRENCE f 1000OAO <br />A I X ea+rdeaCWLf2NERALLVHLITY I-660-114P5718-TCT 0506/01/05 06/01/06 PREM18E8 EAaxuNrca f 100000 <br /> CLAWS MADE a000U0. ~ MEO EKP (AA1'm.Pab~) f SOOO <br /> PERft7W7L dAOVfNJURY f 1000000 <br /> GENERAL AGDREOATE f 20000 QO <br /> ~GFNLAQGRBWTE OM <br />IT 4PPLIE9 PER ~ P0.0DUCT9. COMPpPAGG f$%olYds.d <br /> pp <br />I I POLICY X jECT LOL <br /> 14UT OMOmIE LIABNTY <br /> <br />ANY IWTO <br />COMBINED SINGL@LWR <br />(EP amtlAnO <br />S <br /> ALL OWNED AUTOS <br />SCHEDULED AUT08 BODLLY NUURY <br />IpS, ~nm) <br />f <br /> HIReD AUTUB <br />NONAWNEO AUT09 BODILYWJURv <br />IPR IOdtl~ <br />S <br /> P <br />~~ <br /> RCNRN) <br />(PV f <br /> i DARAOE LIABhRY AUTO ONLY-EA ACCIDENT 1 ' <br /> I ANY AUTO OTHER THAN Fa ACC f <br /> I AUTO ONLY: A00 f <br /> I CXCiBBNNBRELLALUUIILRY EALN OCCIIRRExCE f <br /> OCCUR ~ CIAIMS MADE A66REBATE i <br /> f <br />I <br />DEDUCTIBLE <br />f <br />I RETENTION f f <br /> WORKERS COMPENUTION AKD 70 VLI b ER <br /> EMRAYlRS LIABILRY <br />ANY PROPRIETORIDMTNER/EXECUTA4 <br />E.L. EACH ACCIDEM <br />f <br /> OFFICEWAIFIGER EXCLUDEb? EL. OIBExBE-Ert EMPLOYE S <br />I <br />~ Itya tlRTMOR and9r <br />9PcLJML PRON81gN8 belw <br />EL. DISFA9E-POLICYLIMR <br />f <br />JI <br />I OTHER <br />EeCRIPTIOX OF OPERATKINf I LOCATIONGI VENNfLEG/ OIDLUGNNI6 ADDED BY OIDOMfMRNT! SPKDLL MIpY1GIONf <br />Ra: Hamilton Mine,BeJ:mit No. C-91-078 <br />DIVID4I1 I anouLD <br />Division o£ Min~ral• acid <br />GrOlOgl+ <br />1313 Sharman $t., Room 215 <br />Danvas CO 80203 <br />FOLIGGB e! CAXGELLEO BEFORG TNG <br />DATE THEIIEOF, TXE NUWINO INWREII WILL CNOEAWRTO MAIL 3O DAYiWRrrreN <br />NOTIDG TO TNG CBRTIFICATG XOLDER NAKED TO THE LEFT, BUT FAILURE TO DO GO ONALL <br />INPOfE NOORUOATION OR LwILRY Dv ANY RIND uION TNG INSURER, ITS A08NTD OR <br />SUN-10-2005 08:53RM FRX:615 385 8297 ID:DELTR CORLS PR6E:002 R=97~ <br />
The URL can be used to link to this page
Your browser does not support the video tag.