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GENERAL42364
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GENERAL42364
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Entry Properties
Last modified
8/24/2016 8:11:00 PM
Creation date
11/23/2007 11:44:38 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1984062
IBM Index Class Name
General Documents
Doc Date
8/1/1994
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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III IIIIIIIIIIIII III <br />IHEr~I~IrAfP u~ ~ItS1IZAItrP <br />qF <br />A cE~~ec <br />ro: State of Colorado Date: July 29, 1994 U~ 01 <br />Addreee: DenBver CO 80203ttion Division Ra: See Attachment ~/~/S/ono/~//~N~/5~~99¢ <br />ec~c9y <br />This is to certify that the policies designated below are in force on the date borne by this Certificate. <br />NAME OF INSURED: Cypi'LLS AmaX 1VIlRP.CaIS Company eI aI <br />914u hest Mineral Circle <br />Aadras~: Englewood, CO 80112 <br />T'PE OF INSUPNNCE POLICY I POLICY PERIOD POlIC1' D4RSNAWF$ <br />A) Commercial General Liability - (}1/01/94 - $6,00,000 General Aggregate <br />Claims Made, Retro Date: 4/1/94 04/01/95 $6,000,G00 Product/Cornpleted Operations <br />a) All States GL3197125 Aggregate <br />b) Texas !~L3t97127 32,I)OO,OCO Personal and Advertising Injury <br /> $2.000,(100 Each Occurrence <br /> $2,W0.000 Fire Damage (An}• Ope Fire) <br /> $ 10,()00 Medical Expense (Any One <br /> Petsoe) <br />B) Auto Liability 04/CI/94 - $2.000,000 CSL Each Occurrence <br />e) All States CA 1431816 04/UI/95 <br />h) Texas t A1431819 <br />C) Workers' Compensation 0000404b06 04/01/94 - WC: Statutory <br />Employers' Liability 09/01/94 EL: $2,000,000 Each Accident <br />$2,000,000 Disease -Policy Limit <br />$2,000,000 Disease -Each Employee <br />D) Excess Workers' Compensation EX-316 04/01/94 - Company's Limit of Indemnity Each <br />09/01/94 Occurrence: Statutory <br />Self Insured Retention: $1,(X10,000 <br />This certificate of insurance neither affirmatively nor negatively amends, extends or alters the coverage afforded by those policylies) <br />which numbered above and which issued by companies listed below. <br />Shoul any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail <br />days written notice to the above named certificate holder, but failure to mail such notice shall impose no obligation or <br />liability of any kind upon the company, or upon this agency. <br />INSURANCE COMPANY(IES) ISSUING COVERAGE: <br />A) & B) National Union Fire Ins. Co. <br />C) & D) Old Republic Insurance Company <br />2000 Bering Dr., Suite 900 <br />Houston, Teas 77057 <br />P.O. Box 36429 <br />Houston, Texas 77236fi429 <br />Phone: 713/783L640 <br />Int'1 Telu 166 263 or 166 284 <br />Telerooier 713/783-7241 <br />By <br />Ia88.C l3 <br />Authorized ReOresentative <br />Ell-02J (Rev. 3/89( <br />
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