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1
<br />.. ISSUE DATE
<br />~~./:~N:n. ;CERTIFICATE OF ~ ;-_
<br />.
<br />INSURANCE
<br /> .,
<br />. _
<br />~
<br />PAOOUCEA ~ ~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
<br /> CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
<br /> DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
<br />SEDGWICI: JAMES OF TN, INC. POLICIES BELOW.
<br />P, p. BOX 198121 I COMPANIES AFFORDING COVERAGE
<br />NNOX'JILLE, TN 37939 I _ ____ _ _ _..
<br />(615)58w-91@1 NYA A: OLD REPUBLIC INSURANCE CO.
<br />I
<br /> LETTER
<br />__
<br />INSURED ..__- -_ _-__ _. ._ ii COMPANY EI7
<br />.-_-.,,. LETTER B
<br />Q
<br />CSI
<br />V
<br />
<br />
<br />I CYPRUS MINERALS CO. -
<br />-.E .
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<br />-
<br />__
<br />I COMPANY C: ~
<br />C
<br />AND IT5 SUBSIDIARY CO. ! LETTER
<br />--'_'_ __-_------------ _-__-_-_
<br />P. O. BOX 3c99 ~ EnERNYD D: JUL 1 i 199i
<br />ENGLEWOOD, C^ B@155 _-____ --
<br /> C
<br />OM ERNY E E : Mined Land
<br /> E
<br />RPr•1
<br />~ COVERAGES, - -- - - °"'~_~;~~' .:~-+' " ;~L$fOCI:..
<br />THIS IS 70 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NO7WITHSTANDINO ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAV BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS.
<br />__-
<br />-
<br />CO I TYPE OF INSURANCE ~
<br />LTR1 I I
<br />POLICY NUMBER 'POLICY EFFECTIVE POLICY E%PIRATIONI LIMITS
<br />DATE (MM/DD/YVI ~ DATE (MM/DD/YY) :,
<br />EN
<br />ERAL LIABILITY
<br />O
<br />i ~ j ' GENERAL AGGREGATE i f '
<br />I
<br />-
<br />T
<br />jCOMMEAGAL GENERAL LIABILITY j i i ' PRODUCTS_COMP/OP AGG. _~'~, f
<br />I CLAIMS MADE~OCCUR. ~ i i ~ PERSONAL 6 ADV. INJURY ~ f '
<br />~ER'S 8 CONTRACTOR'S PROT. i / / j / / 'EACH OCCURRENCE ~ f
<br />I
<br />I~ i '' , FIRE DAMAGE (Any ans fire) ; S '
<br />I _ __... _______,.-__ _-_.
<br />I ~ ' ~ MED. IXPENSE (Any ws pxeonU f
<br />j AUTOMOBILE LIABILITY ~ I COMBINED SINGLE f
<br />ZANY AUTO ~ 'I LIMIT -.,
<br /> I
<br />~ALI OWNED AUTOS ,BODILY INJURY
<br />f
<br />SCHEDULED AUTOS - _
<br />I / / ~ / / I (Per oareonl I
<br />HIRED AUTOS
<br />! ~ BODILY INJURY ~ f
<br />~
<br />ANON-OWNED AUTOS I . (Per eccltlsnq
<br />~ i
<br />~
<br />(GARAGE LIABILITY
<br />~~ i
<br />I I j ~
<br />I'PROPERTY DAMAGE 'f
<br />I
<br />i
<br />~
<br />E%CESS LIABILITY I I ' 'EACH OCCURRENCE i f -
<br />
<br />(UMBRELLA FORM I
<br />/ / ~ / / ,AGGREGATE !3 _
<br />.. .OTHER THAN UMBRELLA FORM I
<br /> ' ~ STATUTORY LIMITS
<br />WORKER'S COMPENSATION
<br />'EACH ACCIDENT '., f 1 , @@IL'I, IT k"
<br />AND @c@@a@a6@4 @7/@1/91 '.@7/@1/9c ~, DISEASE-POLICY LIMIT !f 1, @@@, @@!!
<br />EMPLOYERS' LIABILITY j
<br />'DISEASE-EACH EMPLOYEE 't1 @@@,1.1 V'I'.
<br />' OTHER ! I
<br />N%EXCES5 W. C. (1) ~ EXR66 ~@7/@1 /91j@7/@1i9C STATUTORY
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICIE$/SPECIAL ITEMS
<br />(1) EXCESS W.C. APPLIES TO THE FOLLOWING:CO,FSY,PR,UT,AL,AZ,Gq,ID,MT,MO,NM
<br />VT, NV, WV TWENTYMILE COAL CO., FOIDEL CREED MINE PERMIT #C-B~-@56, COLORADO
<br />VAMPA CORL Cp,, MINE #3 PERMIT #C-B4-@6c, MINES lA~ R ECY•.MAN PRRN. #C-B1-@71
<br />CERTIFICATE HOLDER CANCELLATION ~ t~,.,..' =a~+-~: _.
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
<br />STA 7E OF COLORADO MAIL "@ DAYS WRITTEN NOTICE 70 THE CERTIFICATE HOLDER NAMED TO THE
<br />M?hit LAhID RECLRMATION LEPT. ~ LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE~~OBIIGATION OR
<br />'..1 ~ SHEr^.MAhI STREET, SLI I TE c l v LIABILITY OF UPON THE C MPANY, ITS AGENTS QR REPRESENTATIVES.
<br />vENr~FR,CC P@c@' fAUTNOR
<br />I2E
<br />~p/EPRESENTA~IVE n 7 ~ /J { ~~
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<br />~~s
<br />!
<br />.-._-.. _ ^,.-.e,m.~.,.-rm -^.~e"!^:'~.'a"!t"-.=.....,. ,+.,
<br />ACORD 25-5 (7190) ~ ~ ~ ~ T°--,,,.~,I.g¢•.~pjT.~r.r+~.,p++-r ..
<br />.r+.+~;T
<br />~ - OACORDICORPORATION 1990
<br />
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