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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St, Room 215 C O ]- O RA IJ O <br />Denver, Colorado 80203 D I v I S t O N o f <br />Phone: (303) 8663567 MINERAL S <br />FAX: (303) 832-8106 <br />GEOLOGY <br />tembe <br />23 <br />Se <br />2003 I <br />NENC <br />0.E <br />4 <br />p <br />r <br />, C <br />SAf ETY <br />CIEN <br />Stephen Self sin ovens <br />1098 County Road 214 °o"efnOf <br />Silt, CO 81652 Greg E. Walther <br /> Executive Director <br /> <br />Re: Certificate of Liability Insurance, 09/01/03 - 09/01/04 Ronald W. Cottony <br />Division Director <br /> Natural Resource Trustee <br />Deaz Mr. Self <br />Thank you for the subject certificate; however, please have the certificate amended as follows, and <br />re-submit a corrected copy. <br />Item 1: Please add under the DESCRII'TION OF OPERATIONSlVEHICLES/EXCLUSIONS <br />ADDED BY ENDORSEMENT/SPECIAL PROVISIONS the following: <br />"The Eastside Mine - CDMG Permit No. C-1984-063" <br />Item 2. The standard wording of the ACORD CORPORATION 1988 form is not acceptable to the <br />State of Colorado. Please change the cancellation policy to read as follows: <br />"SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIItATION DATE THEREOF, THE ISSUING INSURER WILL ~ ~ MAIL 30 <br />DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT <br />rm~wTmvc nTOrmrn Tmc: An_vwrmo nn nvnnrocwrmA mnrrc~>+ <br />e <br />Please call me if you have any questions. <br />Youts truly, <br />~ /1 Lr/ <br />Byror~G Walker <br />Environmental Protection Specialist <br />Files C-84-064, 2003 Ins Cert <br />C:\WPDOCS\Eastside\ins cert reject.doc <br />Office of 0f8ce of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />