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GENERAL40145
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GENERAL40145
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Entry Properties
Last modified
8/24/2016 7:59:24 PM
Creation date
11/23/2007 10:32:09 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1984063
IBM Index Class Name
General Documents
Doc Date
9/9/2002
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD CERTIFICATE OF LIABILITY INSURANC~RpXpi G DA 91io ~QZ <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />EnRisk Services, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 2624 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />Phone: 817-877 1884 -2624 REC~t~IEp <br />SEP n ~ ~ INSURERA St. Palll Su lus Linea Ins. <br />G 11 INSURER B: <br />Abraxaa Petroleum Corporation <br />Ma. Carol O'Brien INSURER C: <br />P.O. Box 7010 D7 B{Minera4BendGeBID9Y INSURER D: <br />San Antonio TX 78270~~~~g <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 13SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 MAY HAVE BEEN REDUCED BY PAID QlA1M$. <br />LTR TYPE OF INSURANCE POLICY NUMBER DATE MMID DATE MNVDD OMITS <br /> GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,QQQ <br />A X COMMERCIAL GENERAL LIABILITY M[705532$90 Q9~Q1~D2 D9~O1~D3 FIRE DAMAGE (Any one fire) S 1QQr 000 <br /> CLAIMS MADE a OCCUR MEO EXP (Any One person) S § , Q Q Q <br /> PERSONALB ADV INJURV b 1, QQQr QOQ <br /> GENERAL AGGREGATE E 2, QOQ, Q0Q <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E 1, QD Q, 000 <br /> X POLICY PRO LOC <br />JECT <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANV AUTO (Ea a<dtlenp S <br /> ALL OWNED AUTOS <br />BODILY INJURV <br /> <br />SCHEDULED AUTOS <br />(Per person) E <br /> HIRED AUTOS <br />BODILY INJURY <br />E <br /> NON-OWNED AUTOS - (Per acciGenl) <br /> PROPERTY DAMAGE <br /> <br />(Peraai0enp E <br /> GAR AGE LIABIVTY AUTO ONLY-EA ACCIDENT S <br /> ANY AUTO OTHER THAN EA ACC E <br /> AUTO ONLY: AGG b <br /> EXCESS LIABILITY EACH OCCURRENCE S <br /> <br /> OCCUR ~ CLAIMS MADE AGGREGATE S <br /> S <br /> DEDUCTIBLE $ <br /> RETENTION E E <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br />- - - - --- - - ~EL-EAEH-ACCIDENT---- $ - <br /> E.L. DISEASE - EA EMPLOYE S <br /> E.L. DISEASE -POLICY LIMIT b <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BYENDORSEMENT/SPECIAL PROVISIONS <br />It is warranted that no coal mining operations are being conductd by the <br />assured. <br />I.CKIIPIVHIC KVLUCK N ADD)TONAL INSURED: INSURER LERER: liAP1GCLLA 11V1Y <br />DIVGFMI SXOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />GATE THEREOF, THE ISSUING INSURER WILL MAIL ~_ DAYS WRITTEN <br />Division OE Minerals and NOTCE TO THE CERTIFICATE HDLDER NAMED TO THE LEFT. <br />Geology <br />Attn: Mr. Byron Walker <br />1313 Sherman Street ~ -- <br />Denver CO 80203 AUTHORIZED REPRESENTATV~»A _L <br />
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