My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
GENERAL39720
DRMS
>
Back File Migration
>
General Documents
>
GENERAL39720
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/24/2016 7:59:06 PM
Creation date
11/23/2007 10:19:35 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1996083
IBM Index Class Name
General Documents
Doc Date
2/2/2004
Doc Name
Certificate of Liability Insurance
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.
/
2
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
ACORD CERTIFICATE OF LIABILITY INSURANCE CSR TK DATE IMM/DDlYYYY) <br />HOWIE-1 02 02 04 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Putnam Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P. O. Box 991 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Ashland KY 41105 <br />Phone: 606-329-2200 Fax:606-325-7787 - ~ _ INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Federal lnsr 0:0. ~ ~ - <br />-" <br />~ INSURER B: •AmerlCa.n Empire -Ins: -==MF2'~ <br />_y.` Sowie• Resources,_LLC .. - <br />Jeff Muncy _ ~ - ~ ~ ~ r -- - - - ~ ---~ -~- - <br />INSUdERC- PinnacoT Assurance <br />.- PO -Sox- 5057 <br />~ <br />- IAShland KY 81428 <br />INSURER D: ~ '~ ' - <br />i <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 WHICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 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 - P LI Y EFFE TIVE <br />OATS MM/OO/YY FOLIC EXPIRA I N <br />GATE MM/OO/YY <br />LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1000000 <br />A X COMMERCIAL GENERAL LIABILITY 73525270 02/01/04 02/01/05 PREMISES (Ea otturence) 8100000 <br /> CLAIMS MADE X~OCCUR MEO EXP (Anyone person) A10000 <br /> PERSONALBADV INJURY $1000000 <br /> - GENERAL AGGREGATE $ 2000000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E 1000000 <br /> POLICY PRO <br />JECT LOC Em Ben. 1000000 <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br />$1000000 <br />A X ANVnuro 73525270 02/01/04 02/01/05 (Eaaccitlenp <br /> ALL O W NED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Per person) $ <br /> MIRED AUTOS ,' BODILY INJURY _ $ <br /> NON-OW NED AUTO$ - - - <br />, ~ ~ (PerattidenQ <br /> - ~ (' - -- PROPERTY DAMAGE <br /> <br />- <br />"-- _ <br />-(Per accident) - _ _ _ <br />$ <br /> GA RAGE LIABILITY - ~ ~ - -. AUTO ONLY-EA'ACCIDENT ~ $ ~ <br /> ANV AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ SOOOOOO <br />$ $ OCCUR ~ CLAIMS MADE 73525270 O2/Ol/04 02/Ol/O5 AGGREGATE $ <br /> <br /> DEDUCTIBLE $ <br /> X RETENTION $O tlOn $ <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br />C, EMPLOYERS'LIABILITY <br />ANV PROPRIETOR/PARTNER/EXECUTIVE TBD 02/01/04 02/01/05 E.L. EACH ACCIDENT a 1000000 <br /> OFFICER/MEMBER EXCLUDED? <br />- <br />- <br />~ E.L. DISEASE-EA EMPLOYEE <br />- - $ lOOOOOO <br /> If yyes. tlescrbe u3tler <br />- <br />SPECIALPROVISIONSbelow - - <br />- <br />E.L. DISEASE-POLICY LIMIT ----'-- <br />$1000000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Bowie No. 2 Mine (Permit #C-1996-083) -Township 13 South, Range 91 West, <br />6th P.M. <br />CERTIFICATE HOLDER CANCELLATION <br />State of Colorado <br />Division of Minerals & Geology <br />1313 Sherman Street, RM 216 <br />Denver CO 80203 <br />STATEI3 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI( <br />DATE THEREOF, THE ISSUING INSURER WILLi~}~I{1~XD(MAIL 3 O DAYS WRRTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BSSijd~SN3~L§C:Z#ffiRXL`I <br />
The URL can be used to link to this page
Your browser does not support the video tag.