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GENERAL39632
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GENERAL39632
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Entry Properties
Last modified
8/24/2016 7:59:02 PM
Creation date
11/23/2007 10:16:13 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981014
IBM Index Class Name
General Documents
Doc Date
10/14/1983
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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I NNI Il iY a II <br />I '"~~ ~'~ ~I~ IVIII I C I <br />~~W~IIV III I V~IItiYII <br />«~~n;in'~"'[Zl~i1~7i~i:~~~l u Illlllllllllllllllll, <br />~ F r' ~ F r ~ ~ r r <br />1~Ya V fI99 <br />~ <br />rF F r 1' F •', r F <br />NAME AND pODRE$$ OF AGENCY <br />FRED $. JAMES & CO. OF TEXAS INC. COMPANIES AFFORDING COVERAGES <br /> <br />2001 MCKINNEY AVE <br />DALLAS, TEXAS 75201 COMPANY A NATIONAL UNION FIRE INS. CO. OF <br />T <br /> LE <br />TER <br />RECEIVED <br /> COMPANY <br /> LETTER <br />NAME AND ADDRESS OF INSURED OCT 141983 COMPANY <br />DORCHESTER COAL COMPANY LETEER v <br />P . 0. BOX 31049 MINED LAND RECLAMATION dVi Of <br />"Y <br />DALLAS <br />TEXAS 75231 fTER <br />, <br />Cob. Dept of t~tunl Resour <br /> COMPANY r <br /> LETTER L <br />This is to certify that policies of insurance listed below have been issued to the insured named above and are in lone at this time. Notwithstanding any requirement, term or condition <br />of any contract or other document with respect to which this certificate may be issued or may Pertain, the Insurance affordetl by the policies described herein Is subject to all the <br />terms, exclusions and conditions of such policies. <br />COMPANY POLICY Limits of Liabilit in Thousan f <br />LETTER TYPE OF INSURANCE POLICY NUMBER EkPIRAT10N DATE EACH <br />OCCURRENCE pGGREGAiE <br /> GENERAL LIABILITY <br /> BODILY INJURY S 5DD f 5DD <br /> ® COMPREHENSIVE FORM <br /> ®PREMI$E$-OPERATIONS PROPERTY DAMAGE 3 25O f 25D <br />A ®ExPLOSION AND COLLAPSE EGA940-5281 R.A. 8-31-84 <br /> HAZARD <br /> ® UNDERGROUND HA]ARO <br /> ® PRODUCTS/COMPLETED <br /> OPERATIONS HAZARD <br />® CONTRACTUAL INSURANCE BODILY INJURY AND <br />P <br />PERTY DA <br />GE <br />f <br />S <br /> RO <br />MA <br /> ® BROAD FORM PROPERTY COMBINED <br /> DAMAGE <br />INDEPENDENT CONTRACTORS <br /> ® PERSONAL INJVRY PERSONAL IN JURY f 5DD <br /> AUTOMOBILE LIABILITY BODILY INJURY <br />S <br /> rr''{{TT (EACH PER$ONI 25D <br />A L'J COMPREHEN$lyE FORM <br />DOWNED <br />EAA940-5280 R.A. <br />8-31-84 BODILY INJURY <br />(EACH ACCIDENT) f <br />500 <br /> © HIRED PROPERTY DAMAGE S <br /> RODILV INJURY AND <br /> NON~OWNED PpOPERTY DAMAGE f <br /> COMBINED <br /> EXCESS LIABILITY <br /> <br />^ UMBRELLA FORM BODILY INJURY AND <br />S <br />i <br /> PROPERTY DAMAGE <br /> ^ OTHER THAN UMBRELLA COMBINED <br /> FORM <br /> WORKERS'COMPENSATION STATUTORY <br /> and <br /> EMPLOYERS' LIABILITY s ,IeN+ccalw. <br /> OTHER <br />!~ <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLE$ <br />COAL MINE <br />Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- <br />pany will endeavor to mail _].0_ days written notice to the below named certificate holder. but failure to <br />mail such notice shall Impose no obligation or lia bility of any kind upon the company. <br />NAME AND pDDRE$$ OF CERTIFICATE HOLDE R~ <br />COLORADO MINED LAND RECLAMATION BOARD °^TE I$$DED.~1~- <br />PIINED LAND RECLAMATION DIVISION <br /> <br />COLORADO DEPT OF NATURAL RESOURCES ~ i <br />1313 SHERMAN ST. , ROOM 423 AUTHORIZED REPRE$ENTArIVE <br />DENVER, CO. 80203 <br />ACORD 25 (l~]9) <br />
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