GENERAL42202

• Permit No: C1980007
• IBM Index Class Name: General Documents
• Doc Date: 12/13/1983
• Doc Name: Certificate of Insurance
• Permit Index Doc Type: INSURANCE
• Media Type: D
• Archive: No

12-1-63 INSURANCE COMPANY OF NORTH AMERIC~ I~IIII~II~IIlIIIIII
_- ~~ GR~ OF INSURANCE COMPANIES fI I I
RTIFICATE OF INSURANCE yyy
(This Certihcare of Insu ranre neither affi,in ah vely nor negabveb/ a,»?oils, extends
or alters the coveraye, limrti, terms or cnndiuons of the po4_ia; it ce rtif icatesJ
This IS tO C'eftifV Io Lk/I} ~~~~~® COMP ANV CODE$
Ir Mined Land Reclamation Division ~L1L OINA UNDERWRI rERS IN$,CO.
Department of Natural Resources DEC 1;i 1983 I^3 INA OF TEXAS
723 Centinnial Building
1313 Sherman Street tAINED LAND REC.L~/q~MAiION DIVISIO ^ NSURANGEPCOM1IpgN VNS. CO.
Denver, Colorado 80203 CO10. Deot. of Nat
ural Resources U OF NORTH AMERICA
that the following descr,bed policy or pohnes, Issued by The Company as coded below,
providing insurance only !or hazards checked by "X" belcw, have been Issued to Q INA INS. CO. OF ILLINOIS
NAND Atlantic Richfield Company, Its Subsidiaries and subsidiaries
ADDRESS' thereof as now or hereinafter constituted, Atlantic Richfield ©INA INS. CO. OF OHIO FOLD
INSURED Plaza, 515 So. Flower St., Las Angeles, CA 90071
^ (OTHER;- SPECIFVI
covering in accordance with the terms tnereo f. at the following locationlsl.
TYPE OF POLICY HAZAR06 CO. CODE POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY
(a) Standard Workmen's statutory w c.
Compensation & ^ ^ $ One Accident and
Employers' Liability Aggraya re D,sease
(b) General Liability
Premises-Operations hnclud,ng "Im
'
E Each P?ripn
cden lal Contracts
as defln?tl below)

'
^X
~ SCG GO Ol-Ol-84 to *See Eacn ~ ^ Accident
1 ^
c Independent Con tracmrs 515710-9 Ol-Ol-B7 Occurrence
$ He1cxY
o Completed Operations/Products
m
Contractual, ISpec,lic type as
i
l
~ Aggregate-Completetl
P
tlescr~bed
n
ootnote below) _ _ _ ~_ _ _ _ _ _ _ _ _ _ _ _ $ _ _ _ _ Operations/
roducts
Premises-Operations Ilnclud,ng ^ Accident
"Inutlental Contracts" as defined X
^
9^ Each
^ O
m below) ccurrence
$
m
o I
e
d
d
C
O
9^ n n n n
*S~
P
O
n
ep
n
ent
ontractors $
Aggregate-
rem./
per.
~
$
Aggregate-Protective
a ~~ ^
U
o Completed Opera uon s/Products L^J $ Aggregate-Completed
a
Contractual, ISpecdrc type as

X^

~ Qperah Ons/Prpdutls
described in footnote below) $ Aggregate-Contractual
(c) Autamohile Liability
Owned Automobiles a ~ $ *See Each P?, rson
~>
aP Hued Amomobiles n ~ SCA 6317 Ol-Ol-64 t0 He1Cra ^ Acndent
m- Non owned Automobiles ~ ~ Ol_Ol-H7 $ Each ~ ^ Occurrence
_ _ _ _ - _ _ _ _ _ _
~v
w?i Owned Automobiles ® ~ u u n u
BelOW ^Accdent
-
o n Hired Automobiles
~
~ Each
$ ^ Occurrence
a0 Non-awned Automobiles
(d) 2,000,000 Cnnbined
Single Limit
Contractual Footnote: Subject m au the policy rerms applicable, specific wnrrac to al
coverage s pr ov~ded a5 respects his the Intention of the Company that in the event of cancellation of
Check \\11^ a contract the policv nr poiiues by the company, ten 1101 dayi wrinen notice
CApplipahl•I^ purchase ortler agreements between the Insured and: of such can~ellatipn w,ll he gwen to you at the address stared above.
Block //^ all contracts
OF OTHER PARTY
DATE (~t epP hcable(
DESCRIPTION (OR JOB)
Definitions: "Inciden tai contract" means any wntten 111 lease of premises 12) ?asement agreement, a+cept ,n eaion w,N c coon olit~on opera-
tions on or atljacent to a ra,troad, 131 untlertaking to indem nJv a munmipality repuned by ~c I ord moot?, m c n wdh ~k (or
the mumapah tY, (41 su1?track agreement, pr (51 ereva cor ma,n [enance a9r?ement.
thonzed Representative
Lc-l acted Ptd. ... us.A. i. ORIGINAL