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GENERAL39510
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GENERAL39510
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Entry Properties
Last modified
8/24/2016 7:58:57 PM
Creation date
11/23/2007 10:12:46 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1991078
IBM Index Class Name
General Documents
Doc Date
6/2/2003
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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AC6RD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MM/ODIYYYY) <br />:,r <br />DELTCOI 06 O1 03 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Polk S Sullivan Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3401 West End Ave. Ste. 600 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Nashville TN 37203 <br />Phone: 615-385-2860 Fax: 615-385-8358 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED ~~- ~ INSURERA Travelers Indemnit ..Co. of T _ <br /> INSURER B: ~ - _ <br />HoneywOOd' Coal Company INSURER C: ~ _ <br />. <br />95 White Bridge Road <br />ille TN 37205 <br />' N <br />h INSURER D' ' <br />v <br />as <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 />ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO NMICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IB SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDM' DATE MM/DD/YY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ lOOOOOO <br />A X COMMERCIAL GENERAL LIABILITY I-660-114P5718-TCT- 0306/01/03 G6~G1~04 PREMISES(Eeocwrence) $ 100000 <br /> CLAIMS MADE OCCUR - MED EXP (Arty one parson) $ SUGD <br /> PERSONALBADV INJURY $ lOOOOOO <br /> GENERAL AGGREGATE $ 2000000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $Excluded <br /> POLICY X jECOT LOC <br /> AUT OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br /> <br />ANY AUTO <br />(Ea accitlenl) $ <br /> ALL OWNED AUTOS <br />BODILY INJURY ~ <br />$ - <br /> BCHEDULEDAUTOS (Per person) <br /> HIRED AUTOS - <br />_ <br />BODILY INJURY <br />$ <br /> ' NON-OWNED AUTOS' ,. ~ (Peremitlenp <br /> - PROPERTY DAMAGE ~ - <br /> ' (Per acciaenq $ <br /> GARgGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANV AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> E%CESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE AGGREGATE 8 <br /> $ <br /> DEWCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATON AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br /> <br />ANV PROPRIETOR/PARTNER/EXECUTIVE - ~ - - - <br />- - - --- - <br />~ -. <br />- - ~ - EL EACH ACCIDENT.__ $ <br />~ ' <br /> OFFICERIMEMBER EXCLUDED? <br />E. L. DISEASE-EA EMPLOYEE <br />$ <br /> If yes, tlasaibe untler <br /> SPECAAL PROVISIONS below E. L. DISEASE-POLICY LIMIT $ <br /> OTHER <br />DESCRIPTON OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Re: Hamilton Mine, Montross County, Colorado, DMG Permit No. C-91-07B <br />JUN 0 21003 <br />Givision of Minerals and GeBlrv~~• <br />Division of Minerals and <br />Geology <br />Attn: H. Ranney <br />1313 Sherman St., Room 215 <br />Denver CO 80203 <br />ACORD 25 !2001 /DRI <br />DIVIMIl ~ SHOULD ANV OF THE ABOVE DESCRIBED POLICIES <br />DATE THEREOF, THEISSUINO INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER ITS AGENTS OR <br />1988 <br />
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