CERTIFICATE NUMBER :.
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<br />lf7~~~~I'LTG Off' II `f~~A-f~~~IG -NYC-Om 14151 B-04
<br /> PRODUCER THIS CERTFCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
<br /> MafSh USA IDC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
<br /> 1166 Avenue Df Americas POLICY. THIS CERTIFlCATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
<br /> NY 10036
<br />New Yolk AFFORDED BY THE POLICIES DESCRIBED HEREIN.
<br /> ,
<br /> Attn: KEN HELM NEWYORK.CERTS®MARSH.COf•,f~ECEIVED
<br />t"i
<br />COMPANIES AFFORDING COVERAGE
<br /> COMPANY
<br /> 006046---OS-O6 A NSA
<br /> INSURED COMPANY
<br /> W. R. GRACE & CO. g WA
<br /> 7500 GRACE DRIVE
<br /> COLUMBIA, MD 21044 Division of Minerals & Geology COMPANY
<br /> C HARTFORDINSURANCE OF THE MIDWEST
<br /> COMPANY
<br /> D HARTFORD FIRE INSURANCE COMPANY
<br /> G`tIUEH¢LGES ,__ . ,c~inea<esBpersBnrEre~'aacesary~pravfpusTy fssBBB C+~t~ta lDrtlTe!c~ireNaB Hared beinw, .. _.,•. ,. -~ 4 . ., ,.,.:, ,
<br /> THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
<br /> NOTWITHSTANDING ANV REOUIREMEM, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAV BE ISSUED OR
<br /> MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND IXCLU310NS OF SUCH POLICIES.
<br /> AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS.
<br /> CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PODGY EXPIMTION LIMITS
<br /> LTR DATE (MM/OD/YY) DATE (MM/DD/YY)
<br /> - G ENERAL LIABWTY SELF INSURED 06/30/05 06/30/06 GENEPAL AGGREGRATE $ 5,000,000
<br /> X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 5,000,000
<br />
<br />~ CLAIMS MADE OCCUR PERSONAL BAW IW URY $ 5,000,000
<br /> ~ OWNERS & COMRACTOR'3 PROT EACH OCCURRENCE $ 6,000,000
<br /> X SELF-INSURED FIRE DAMAGE(Any ane fire) $ 5,000,000
<br /> W.R. GRACE R CO MED IXP (Any one person) $ EXCLUDED
<br /> D A UTOMOBILE LIABILITY 10 CSE C47908 (ADS) O6/30Po5 06!30/06
<br /> COMBINED SINGLE LIMIT $ 2,000,000
<br /> C X ANV AUTO 70 CSE C47909 (TX) O6f30Po5 06/30/06
<br /> C ALL OWNED AUTOS 10 CSE C47908 (IN, OK) 06/30/05 06!30/06 BODILY INJURY
<br />
<br />D
<br />SCHEDULED AUTOS
<br />21 CSE C47910 (PR)
<br />06/30/05
<br />O6f30/06
<br />(Per person) $
<br /> HIRED AUTOS BODILY INJURY
<br />$
<br /> NON-OWNED AUT03 (par acdtlenq
<br /> PROPERTY DAMAGE $
<br />
<br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
<br /> ANY AUTO OTHER THAN AUTO ONLY: -_ "'
<br /> EACH ACCIDENT $
<br /> AGGREGATE $
<br /> EXCESS LIABILITY EACH OCCURRENCE $
<br /> UMBRELLA FORM AGGREGATE $
<br /> OTHER THAN UMBRELLA FORM $
<br /> D WORKERS COMPENSATION ANO CT
<br />FL
<br />GA
<br />IA)
<br />10WNC47906 (CO O6I30/05 O6I30/O6 J( WC STATU- OTH-
<br /> ' ,
<br />,
<br />,
<br />, TORY LIMITS ER '~
<br /> EMPLOYERS
<br />UABIUTV (MO,NE,NV,NY,OH,OR,SD,WA,WV) EL EACH ACCIDEM $ 2,000,000
<br /> C THE PROPRIETOR/ X INCL 10WNG47906 (AR,AZ,DE,IL,KS,LA) 06/30/05 O6/30Po6 EL DISEASE-POLICY LIMIT $ 2,000,000
<br /> PARTNERS/EXECUTIVE
<br />OFFICERS ARE:
<br />IXCL
<br />(MA,MD,ME,MI,NH,NJ,NM,OK,PA)
<br />EL DISEASE-EACH EMPLOYEE
<br />$ 2000000
<br /> OTHER
<br /> DESCRIPTION OF OPERATIONSrLOCATIONSIVEHICLES/SPECIAL ITEMS
<br /> The coverage antl Ilmils statetl aDOVe apply to PermK #Ce0-003
<br /> GEfiTGAT~ }KiLDER ._,. ,..~. __.~_, :~ ~,< < , ,. , ~~_. ~ . CANt~LU4TlQM-u ~ ,...~,~,. _~_u ~ ~,~ .~ ~ _~~ .. ~~ , ~ ~ -
<br /> SHOULDANV OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE IXPIFiATION
<br /> Colorado Division of Minerels and DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS
<br /> Geology WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH
<br /> Attn: Jim Stark NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER
<br /> 1313 Sherman Street -Room 215 AFFORDING COVERAGE, 1T9 AGEMS OR REPRESEMATIVES, OR THE ISSUER OF THIS
<br /> Denver, CO 80203 CERTIFICATE.
<br /> MARSH USA INC
<br />Bv: Thomas J. Edntlge %7'Ip~YH0.d ¢-• '~
<br /> N~dl{5f6$i :VALID AS OF ~DN2S/05 `s
<br />
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