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GENERAL42121
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GENERAL42121
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Entry Properties
Last modified
8/24/2016 8:10:40 PM
Creation date
11/23/2007 11:36:40 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1983059
IBM Index Class Name
General Documents
Doc Date
6/27/2006
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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S <br />~h <br />' DATE(MM/DD/VV) <br />ACORD,M CERTIFICATE OF LIABILITY INSURANCE o6/zo/o6 <br />PnoouceR <br />Aon Risk services, me of Florida THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />222 Lakeview Avenue AND CONFERS NO RIGHTS UPON THF, CERTIFICATE HOLDER. THIS <br />Suite 510 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />west Palm aeach FL 33401 USA COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> INSURERS AFFORDING COVERAGE <br />Pttove- 866 283-7124 FRS- 866) 430-1035 <br />., t <br />D <br />INSURED INSURER A: HartfO rd Fl re insurance CO. <br />~~~~ <br />Oxbow carbon & Minerals LLC 7~ V ~ nvsoRER H. Federal rnsurance company <br />1601 Forum P1 II` <br />Attn: Donna J. Gul bransen <br />west Palm Beach FL 33401-8101 u5A <br />I nnpC <br />lN0 INSURERC Westchester 5urpl us Lines ins Co <br />,I <br />N 2 7 ( <br />JU INSU <br />RER D'. <br /> andG y <br />FIRERE <br />COVERAGES This Certificate is not intended [o 1 orsements, caveTaRes, [eons, conditions and exclusions of[he policies shown. SIR May App y <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT 70 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN, THE INSURANCE AFFORDED HY THE POLICIES DESCRIBED HEREIN ]S SUBIECT 70 ALL THE TERMS, EXCLUSIONS AND COND1TlONS OF SUCH POUCffiS. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C LAIMS. <br />INSR <br />LTR <br />TYPE OF WSURANCE <br />POLICY NUMBER POLICY EFFECTIVE <br />DATE(MM\pD\YV) POLICY EXPIRATION <br />DATE(MM\DD\YY) <br />LIMITS <br />B GENERAL UAHIUrY 35863379 <br />l 06(01/06 06/O1JW EACH OCCURRENCE 57,000,000 <br /> - Genera <br />Eiability- <br />Y <br /> X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anv ane Ere) $1,000,000 <br /> CLAIMS MADE^X OCCUR MED EXP (Anv one PVSOn] $10,000 <br /> PERSONAL&ADV MRJRY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> <br /> GEN'L AGGREGATE LIMIT APPLES PER: <br />PRODUCTS-COMP/OP AGG <br />$2,000,000 <br /> PRO- <br />^ <br />~ <br /> POLICY <br />LOC <br />fECT <br />A A UTOMOBILE LIABlLCCY 20UENZQ6229 09/01/0$ 09/01/06 COMBINED SINGLE LIMIT <br /> HD$ine$$ ADTOInObl72 - Texas (Ea accident) $1,000,000 <br /> X ANY AUTO <br /> ALL OWNED AUTOS BODILY M1URY <br /> SCHEDULED AUTO$ (Per P~°N <br /> HIRED AUTOS BODILY MIURY <br /> NON OWIJED AUTOS (Per eccidmt) <br /> PROPERTY DAMAGE <br /> (Per acddrnQ <br /> <br /> GARAGE LIABILITY ADTO ONLY - EA ACCIDENT <br /> ANY AUtO OTHER THAN EA ACC <br /> AUTOONLY . <br /> AGG <br />C EXCESS LIABILITY 6 1 9 7 0 <br />b <br />ll <br />bil 06/01/06 O 7 EACH OCCURRENCE $10, 000, DDD <br /> re <br />a Lia <br />ity <br />um <br /> X <br />OCCUR ^ CLAIMS MADE AGGREGATE $10,000,000 <br /> ~ ~ -.. Y _ - - _ <br /> DEDUCTIBLE <br /> X RETENTION 310,000 <br /> WORKERS COMPENSATION AND <br />' WC STAN- OTH- <br />TORY LIA T ER <br /> LIABILITY <br />EMPLOYERS E4 EACH ACCIDENT <br /> E.L. DISEASE-POLICY LIMB <br /> E.L. DISEASE-EA EMPLOYEE <br /> OTHER <br />DESCRIPTION OF OPERAIIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEA7ENT/SPECIAL PROVISIONS <br />RE: Terror creek company. c-1983-059 commercial General Liability covers use of explosives. Division of <br />Minerals & Geology is named as an Additional insured a5 required by written contract but limited t0 the <br />operations of the insured under said contract, and always subject to the policy terms, conditions and exclusions. <br />ER:TIAICABE- O - ER ~ - - -CANOE` ~LA . ON - <br />DI VI SI OD Of Ml nefdl5 & Geology SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLEDBEFORE THE EXPIRATION <br />"^" <br />` <br />^ <br />1313 Sherman street, ROOM 213 MAIL <br />DATE THEREDF,THE ISSUING CDMPANY WILL <br />~..oc~.:eR- <br />.o <br />Den Ver CO 80203 USA 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> HUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY <br /> OF ANY KMD UPON THE COMPANY, ITS AGEMS OR REPRESENTATIVES. <br /> ~! <br />AUTHORIZED REPRESENTATIVE ~~ ~ /~j~ ~. ~__ <br />d f., .c ....(' <br />.4C RD25-S" 7/ 7 CO ,C... P~ T 1Vy 88 <br />`c <br />S <br />Z <br />C <br />2 <br />C <br />n <br />a <br />C <br />n <br /> <br />
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