My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
GENERAL39826
DRMS
>
Back File Migration
>
General Documents
>
GENERAL39826
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/24/2016 7:59:10 PM
Creation date
11/23/2007 10:22:57 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981022
IBM Index Class Name
General Documents
Doc Date
8/8/1996
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.
Page 1 of 1
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 CE 1'I~IC/~T.E O:F ~1~18tt.1 'T~ I. SURAfVCE III'II~II~IIIllllll <br />~ <br />PRODUCER <br />SedgWlC k James Of Ga. , In[. THIS CERTIFICATE IS ISSUED AS A A ggg I <br />SU1te 500, SOUth TOWer ONLY AND CONFERS NO RIGHTS Urvn Ina E.~n l,rla.n,c <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3333 Peachtree Rd. NE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Atlanta, Georgia 30326-1043 COMPANIES AFFORDING COVERAGE <br /> COMPANY <br /> A Federal Insurance Com any <br />INSURED COMPANY <br />Oxbow Carbon & Minerals Inc. B Colorado Com Insurance Auth. <br />Pacific Basin Resources CDMPANY <br />1601 Forum Place ~ <br />West Palm Beach FL 33401 i COMPANY <br />I D <br />_ _ <br />"~ R~" 3'd ~' [^i4 A~ iPJE& ~ F3dY t i d R ~-~~'tl~ e ~N"~a,',°~ s~~~.~pp~~~. a[ e. . ~, x e~ ~ <br />ERAQE$ <br />" <br />~ <br />4? <br />~° <br />V <br />' <br />~ <br />" <br />~ <br />~ <br />. . . <br />x ... ,. ass m..qa,. .,::~ . <br />., <br />n...4.P,>,~. ,.n <br />nsx .~§,.~s•.Z.h <br />Z°$.(9 <br />;e, .,~.F~g+~8 <br />~AS'F <br />¢.k <br />3 <br />,'~a. <br />8. <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />El(CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />CO <br />LTR TYPE OF INSURANCE <br />- POLICY NUMBER <br />- - - - - - POLICY EFFECTIVE POLICY E%PIRATION LIMRS <br /> DATE (MMIDD/YY)- DATE (MMIDD/YY) - -- - - ~ - <br />A GEN ERAL LIABILITY 37104268 7I21I9G 721 ~97 GENERAL AGGREGATE S 2000000 <br /> X COMMERCIAL GENERAL LIABILITY PRODUCTS -COMP/OP AGG E S 000000 <br /> CLAIMS MADE X^ OCCUR PERSONAL 8 ADV INJURY $ 1 000000 <br /> OWNER'S fl CONTRACTOR'S PROT EACH OCCURRENCE E 1 000000 <br /> FIRE DAMAGE IAny one Ilrel E 1 OOOOO <br /> MED EXP Anyone arson) E 10000 <br />A AUT OMOBILELIABILRY .r~ <br />730772$8 7/21/96 7/21/97 <br /> X ANY AUTO COMBINED SINGLE LIMIT E 1000000 <br /> X ALL OWNED AUTOS <br />BODILY INJURY <br />E <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br />BODILY MJURV <br />$ <br /> X NON-OWNED AUTOS (Per acci0en1) <br /> <br /> PROPERTY DAMAGE b <br /> GARAGE LIABILTY AUTO ONLY ~ EA ACCIDENT $ <br /> ANY AUTO OTHER THAN AUTO ONLY <br /> EACH ACCIDENT $ <br /> AGGREGATE S <br />A EXCESSLIABILRY 79083801 7/21/96 7I21~97 EACH OCCURRENCE S SOOOOOO <br /> X UMBRELLA FORM i AGGREGATE $ SOOOOOO <br /> OTHER THAN UMBRELLA FORM $ <br />B WDRKERS COMPENSATION AND 001 OOB37 1/01/96 1/O1 /97 X WORy LAMJB ER ~"' ~""''<"~<'«.<:<•«-' <br /> EMPLOYERS' LIABILITY EL EACH ACCIDENT f 1000000 <br /> THE PROPRIETOR/ <br />PARTNERSIE%EC <br />T <br />E INCL EL DISEASE ~ POLICY LIMIT $ 1 000000 <br /> U <br />IV <br />OFFICERS ARE' EXCL EL DISEASE-EA EMPLOYEE E 1000000 <br /> OTHER <br /> ~~~~~vrD <br />DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS <br />Re: Somerset and Sanhorn Creek Mines - DMG Permit No. 0-81-022. <br /> Division of Minerals & Geology <br />~CANCELL~ATION ..~cz ~; ` ` <br />CERtTIf7CA5E=HOLDER <br />~ <br />~~ <br />~ <br />`" r <br />r~ <br />n2 <br />. <br />, . <br />.. <br />.a ~. <br />s <br />: , <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />D1V151On of Minerals & Geology E%P <br />IR <br />ATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />Attn: Dave Berry ' <br />^ <br />~Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />1313 Sherman St. Room 21 S BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />Denver, CO BO2O3 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESEN~~VES. <br /> AUTHORIZED REPREBENTATIV_ E _ ~ -s~~ <br />C~TQ~.+_ .,~. Q Q_ <br />M.. <br />....._..... <br />.. <br />. ~ <br />.. <br />r <br />~ <br />s • :..~ <br />ACORD~25=~`~W/9 1~ ... 'a ,~a~a~ ^.~aatas; <br />~ 988'~ <br />3~c?;i~~F .. ~ pE , R ..APO ...TIOIJ~.1 <br />'iM ~ ° ~v _ ~ .. Kan. ,- -. - ... ... .~~. ~..~ . e. ~. -. ` ~ /'Y- <br />
The URL can be used to link to this page
Your browser does not support the video tag.