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GENERAL40114
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GENERAL40114
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Last modified
8/24/2016 7:59:23 PM
Creation date
11/23/2007 10:30:54 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1983059
IBM Index Class Name
General Documents
Doc Date
6/25/2007
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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.' <br />A ORD,~ ~ ~ <br />~R~IFIGATE OR„I,IABiLI + - , :-~ y ~. ~yh' DATE(MM~DD YY) <br />T_Y ILYSUR2TCE,~, ~,„~~. ~ oe/u/o7 <br />PROxuceR ~ <br />Aon Risk Services, xnc of Florida THIS CERTIFICATE IS LSSI7ED AS A MATTER OF INFORMATTON ONLY <br />222 Lakeview Avenue AND CONFERS NO RIGHTS UPON THE CERTQ~'ICATE HOLDER THIS <br />Bui to 510 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />west Palm Beach FL 33401 USA COVERAGE AFFORDED BY THE POLICIES BELOW. <br />exoNe- 866 283-7122 FAX- 847 953-$390 QVSTIRERS AFFORDING COVERAGE <br />WSURED INSURER A: HdrtfOrd Fire InsUrdnce CO. <br />oxbow carbon & Minerals LLC WsImFRa: Pacific indemnity Co <br />1601 Forum Pl <br />Attn: Donna ]. Gul bransen WSURER C: Westchester Fire InsU ranee Co <br /> <br />west Palm Beach FL 33401-8101 USA u <br /> 4 <br /> W SURER D: <br />.C <br /> <br />WSUAER E: Y <br />~ <br />F`>' VERAGES'"I~1sCett?fiDetc u;wEt~xtlendBtl tO... ~BBibDdwseDien '^-COV ~ 'ffif11iS~xOABlI1DRSta1DE'EXCIUSt089=0YH1C3 IICAC5`9I5U'w13.'~''as`i:.,+°.ISIRiMa ~~1AP:`Y y <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEIN ISSUED TO THE INSURID NAMED ABOVE FOR THE POLICY PERIOD INDICATID, NOTWHHSTANDING Z <br />ANY REQUBiIIvvffi.tiT', TERM OR CONDITTON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 WHICH THIS CERTIFICATE MAY HE [SSUID OR MAY ~ <br />PERTAIN, TT-]E INSURANCE AFFORDED BY THE POLICIES DESCRIBED $IDtEltd IS SUBIECT TO ALL THE TERMS, EXCLUSIONS AND CONDTITONS OF SUCH POLICIES. <br />AGGREGATE LASTS SHOWN MAY HAVE BEEN RIDUCED BY PAB) CLABviS. <br />WSR <br />LTR <br />TYPE OF WSURANCE <br />POLICY NUMBER POLICY EFFECFIVE POLICY EXPIRATION <br />LTMTTS <br />< <br /> DATE[MM\DD\W) DATE(MMD)D\W) M <br />m <br />B GENERAL LIABILFFY 35863379 06/01/07 06/01/0$ EACH OCCURRENCE $1,000,000 m <br /> General Liability rv <br /> X COMMERCIAL GENERAL LIABRITY FIRE DAMAGE(Anv one fire) $1, 000, 000 N <br /> CLAIMS MADE ^X OCCUR MED EXP (Am one person) E10, 000 O <br /> ~ <br /> PERSONAL&ADV WRBtY E1, 000, 000 <br /> GENERAL AGGREGATE $2 <br />000,000 <br /> , <br /> GEN'L AGGREGATE LNUT APPLES PER: <br /> PRO- <br /> <br />^ <br />^ PRODOCTS-COAD'IOP AGG 52,000,000 <br />~ <br /> POLICY <br />LoC <br />,EGT z <br /> d <br />A A UTOMOBILE LIABB.RY 2OUENZQ6229 09/01/06 09/01/07 COKffiWED SWGLE LADT 4u~. <br /> BDSlness AUtOmObl le - Te%a5 (Fi accident) $1,000,000 - <br />ce. <br /> X ANY AUTO i <br />Y <br /> ALL OWNED AUTOS BODILY WNRY V <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS BODRY WNRY <br /> NON OWNED AUTOS (en acddmp <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> <br /> GARAGE LUBB-TTY AUTO ONLY - EA ACCIDENT <br /> ANY AUTO OTHER THAN EA ACC <br /> AUTO ONLY <br /> AGG <br />C EXCESS LIABILITY G 1 06/01/07 1 EACH OCCURRENCE $10,000,000 <br /> - <br />x OCCUR ~ CLAD.IS MADE umbrella Ll abil lTy <br />^ ~- -"- - - ~ - !~ AGGREGATE $10,000,000 <br /> <br /> DEDUCTB3LE <br /> X RETENHON $10,000 <br /> WORKERS COMPENSATION AND C STATU- OTH- <br /> ' ~~ T RY LIMIT ER <br /> EMPLOS <br />ERS'LIABB.TIY ~ 'I <br />00 l <br />E.L. EACH ACCDEM - <br /> ```` <br />,v\~ 2 5 2 <br />a~)on. E.L. DISEASE-POLICY LIMIT' <br /> ReG)am <br />n of aietY E.L. DISEASE-EA EMPLOYEE <br /> oreER Ml~ln ~ <br /> <br /> rv~ <br />DESCR~TION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDOASEA~M/SPECIAL PROVISIONS <br />RE: Terror Creek Company. C-1983-059 Commercial General Liability covers use of explosives. Division of <br />Minerals & Geology is named as an Addltlonal insured as required by written contract but llmlted to the <br />operations of the insured under Bald contract, and always subject to the policy terms conditions and exclusions. <br /> <br />DI VI SI On Of Ml nerals Br GEOI Oyy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />1313 Sherman street ROOM 21$ DATE THEREOF, THE ISSUWG COMPANY WRL EIJB6kV9RT9 MAR <br /> <br />Denver CO 80203 USA 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />..re <br /> BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILRY <br /> OF ANY KIND UPON THE COMPANY. TIS AGENTS OR REPRESE <br />MATIV <br />ES. ~ <br /> ~~ <br />~~ <br />//!! y <br />AUTHORIZED REPRESENTATIVE ~-l.-lc ~.,:l~.~~~ ~. T""'--- _ <br />,.. ...:,. a.. i. 2p+ ._.:....: __. .,. ~. t?: c 7. ... +!.C ..... e v.e~iH'T rvL°eY.... h:.:_._:=° <br />
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