My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
GENERAL41918
DRMS
>
Back File Migration
>
General Documents
>
GENERAL41918
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/24/2016 8:10:20 PM
Creation date
11/23/2007 11:29:42 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981008
IBM Index Class Name
General Documents
Doc Date
1/9/2004
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
Page 1 of 1
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
ACORD CERTIFICATE OF LIABILITY INSURANCE CSR MA DATE IMM/DD/YYYY) <br />WESTE-1 O1 07 04 <br />E <br />~® <br />~~~~'~ T <br />T <br />I <br />Companies <br />Hays HOLDER. <br />H S CERTIFICAT <br />E DOES T AMENDREX <br />END OR <br />80 South Sth Street #700 <br />4 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Minneapolis MN 55402 AN Q ~ Z~0 <br />Phone: 612-333-3323 Fax: 612-37'7270 INSURERS AFFORDING COVERAGE NAIC# <br /> <br />a0 <br />INSURED <br />n D{ Minerals an INSURER A: Chubb Ci1StOm Insurance Co. <br />Drvt$ia <br /> INSURER B: <br />Illinois Union Insurance Co. <br />Western Fuels Association,Inc. <br /> <br />Robert NorrQard INSURER C: <br />P. O. SOX 33424 <br />Denver CO 80233 INSURER D: <br /> <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIB CERTIFICATE MAY SE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO lLLL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DDM' LIMITS <br /> GENERAL LU181LITY EACH OCCURRENCE $5,000 OOO <br />A X COMMERCIAL GENERAL LIABILITY 79545130 01/01/04 01/01/05 PREMISESEE aoccurence) $ <br /> CLAIMS MADE ~ OCCUR MED EXP (Any ane person) $ <br /> PERSONAL 8 ADV INJURY $ <br /> GENERAL AGGREGATE $2, DOD, DGD <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2, DUD OOO <br /> POLICY jE~ LOC Em B@n. 2 DUD DDD <br /> AUT OMOBILE LVIBILITY COMBINED SINGLE LIMIT <br />$ <br /> ANY AUTO (Ee axitlent) <br /> ALL OWNED AUTOS <br />BODILY INJURV <br />$ <br /> SCHEDULED AUTOS (Par parson) <br /> HIRED AUTOS <br />BODILY INJURV <br />$ <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> <br />(Per accident) $ <br /> GARAGE LU1BILffY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLALU181LIry EACH OCCURRENCE $20,000,000 <br />B X OCCUR ~CIAIMSMADE XOO 621810496 01/01/04 01/01/05 AGGREGATE $20,000,000 <br /> 8 <br /> DEDUCTIBLE $ <br /> }( RETENTION $SO,000 $ <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ <br />- OFFtCERIMEMBEREXCttlDED9' --- ' --' - -' --- -- -- E.L. DISEASE - EA EMPLOYEE S <br /> It yes, tlascdEe under <br /> SPECIAL PROVISIONS bebw E. L. DISEASE-POLICY LIMIT $ <br /> OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES /EXCLUSIONS ADDED BV ENDORSEMENT / SPEGU\L PROVISIONS <br />Evidence of Insurance as respects <br />New Horizon Mine in Nucla, CO (Permit #C-81-008). <br />Colorado Mined Land <br />Reclamation <br />Mind Land Division <br />1313 Sherman Street, <br />Denver CO 80203 <br />COLOR-2 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIC <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAILURE TO DO BO SHALL <br />RM 215 IMPOSE NO OBLIGATION OR LU181LRY OF ANY KIND UPON THE INSURER, RS AGENTS OR <br />©ACORD CORPORATION 198E <br />
The URL can be used to link to this page
Your browser does not support the video tag.