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GENERAL40683
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Entry Properties
Last modified
8/24/2016 7:59:49 PM
Creation date
11/23/2007 10:48:45 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981022
IBM Index Class Name
General Documents
Doc Date
8/16/1995
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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<br />r~ <br />A1./II:D. ~~~ ~~~~~~~~~~~~~ ~~~ <br />PflOD~~ SedgWick James Of 6a.. Inc. THIS CERTIFICATE IS ISSUED AS A M/ ggg <br />Suite 500. South Tower ONLY AND CONFERS NO RIGHTS UWn Inc McnIIE'IE.HIC <br /> HOLDER. THIS CERTIFlCATE DOES NOT AMEND, El(TEND 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 CompanL <br />INSURED CpAPANY <br />Oxbow Carbon & Minerals Inc. 9 <br />& Pacific Basin Resources Cp,Ipµy ,, <br /> <br />1601 Forum Place 1 <br />~ FtEr <br />EIVE~ <br />West Palm Beach FL 33401 , <br />~`" <br />COMPANY <br /> UG 1 <br />D <br />A <br /> _ <br />,,tt~I~-~, <br /> • <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN <br />E FOR THE <br />P <br />R <br />E <br />D <br />N <br />A <br />M <br />E <br />D <br />A <br />BO <br />V <br />OLICY PERIOD <br />S <br />U <br />F <br />~ <br />} <br />A <br />@( <br />~~ <br />I <br />~ <br />~ <br />p <br />~ <br />T <br />p <br />~ <br />~ <br />Q <br />Q <br />S <br />YE <br />I <br />~ <br />CE <br />O <br />O <br />O <br />( <br />CERT FICATE MAY BE <br />PER <br />SSUED ORR MA <br />TA METH INSURAN SCF11t1EY1~1-IEKiEIN~1S-STIWECT TO <br />ItI'L THE <br />TERMS, <br />AFFORDE <br />D BY THE P <br />ACIES DE <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. <br />~ <br />LTi1 TYPE OFINSUIUINCE PODGY NUMBER ' <br />H LIMBS <br /> DATE (MMlDDIYY) DATE (YYIDDM <br />) <br /> GEN FAAL LIABIDfY /21/96 GENERAL AGGREGATE f 2000000 <br /> COMMERCUL GENERAL LIABILfiY PRODUCTS COMPAJP AGG f 1000000 <br /> CLAIMS MADE ®OCCUR PERSONAL d ADV INJURY E 1000000 <br /> OWNER'SB CONTMCTOR'S PROT EACH OCCURRENCE f 1000000 <br /> FIRE DAMAGE (Myone lne) f 100000 <br /> MED E%PlMyane Person) E 10000 <br /> avr afloBlLE UnBILRY 3 7/ 1 5 7/21/96 <br /> ANY AUTO COMBINED SINGLE LIMIT E 1 000000 <br /> ALL OWNED AUTOS <br />BODILY INJURY <br />E <br /> SCHEDULED AUTOS IPeI person) <br /> NIRED AUTOS <br />BODILY INJURY <br />E <br /> NON-0WNED AUTOS (P°` aooEenl) <br /> <br /> PROPERTY DAMAGE E <br /> GARAGE LLABILT' AUTO ONLY ~ EA ACCIDENT E <br /> ANY AUTO OTHER THAN AUTO ONLY <br /> I EACH ACCIDENT f <br /> <br /> AGGREGATE E <br /> E%CESS DABIIRY 6 I EACH OCCURRENCE E SO OOOO <br /> UMBRELLA FORM ( AGGREGATE LE SCVVOOO <br /> OTHER THAN UMBRELLA FORM E <br /> WORKERS COMPENSATION AND <br />EMPLOYEAS'LIABIDTY b I` ,STATUTORY UMrtS <br />-- -' I~ <br />I - <br /> <br />EACH ACCIDENT I ~6 <br />f <br /> <br />THE PROPRIETOIU INGL <br />PARTNERSIE%ECUTIVE <br />! DISEASE ~ POLICY LIMB ~ c~T~c~cPi~c- <br />E 'wv V V v <br /> TJOO-0 <br /> OFf K:F.RS ARE EXCL j DISEASE EACH EMPLOYEE b <br /> OTHER T <br />DESCRIPOOH OF OPERATONS/LOCAHONSNEHICLESSPECIAL ITEMS <br />CERTIFlCATE"HOLDER ~ CANCELLATION, <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOPE THE <br />Division O f Minerals &: Geology E%PIRATION DATE THEREOF, THE ISSDING COMPANY WILL elm~AVaa.o MAIL <br />~t t n : Tony Wa 1 d r o n 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />1313 Sherman St. ROOM 215 ~-.-W~~y~,~,,,~,,,,o„~~,.,~~~,~„~~~,,,,,,~„~.. <br />Denver, CO 80203 D~..AN.. wcNlr yll011rwlo- ~aeA~nAwr, 116~AViRR~TT ~lIIATVCS <br /> AUTHORREO REPRESENTATIVE <br /> y~ ~ ~ ~ ~ <br />C L'R..a-~-e~2. (~j~ <br />ACORD <br />25 <br />S (3193) 33- 14 <br />e ACORD CORPORATION 1993 <br />r <br />, <br />- <br />... .. ._,.." , <br />,:y , ,~., ,y <br />~y.:,;: , _ <br />
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