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GENERAL42714
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GENERAL42714
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Entry Properties
Last modified
8/24/2016 8:11:29 PM
Creation date
11/23/2007 11:56:05 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981022
IBM Index Class Name
General Documents
Doc Date
6/25/2007
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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" <br />~ ~; ~T I ., ,I DATE(MM/DD/VYYY) <br />~ IN,S~.i[~' :,.. `". . ,. .,.. "' a: 06/21/2007 <br /> THIS CERT~ICATE IS ISSUED AS A MATTER OF BVFORMATION ONLY <br />AND CONFERS NO RIGHTS UPON TAE CERTIFICATE HOLDER THIS <br />CERTIFICATE DOES NOT AMEND, ERTEND OR ALTER THE <br />COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> INSURERS AFFORDING COVERAGE NAIC N <br /> wsukER A: Pacific indemnity co 20346 <br /> INsuRER B. Westchester Fire Insurance co 21121 <br /> INsuaERC Hartford Fire Insurance Co. 19682 <br /> INSURER D. <br /> INSURER E <br /> -SIR Ma .: <br /> VSURID NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />DOCUMENT W17H RESPECT TO NRllCH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />N IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS AND CONDTIIONS OF SUCH POLICIES. <br /> Po W CY EFFECTIVE <br />DATE(MM1DDAYY) POLICY EXPDtATION <br />DATE(MMIDDAYY) <br />LLMITS <br /> 06/01/07 O6/O1/OS EACH OCCURRENCE f1, 000, 000 <br /> DAMAGE TO RENTED <br />PREMISES (Ea ocwrence) $1, DUD, OOO <br /> (Am ooa pcrsov) <br /> PERSONAL&ADV BVIURY $1,000,000 <br /> GENERAL AGGREGATE E2 <br />000, 000 <br /> , <br /> -RODUCTS-COMP/OP AGG $2, OOO, D00 <br /> <br /> 06/01/07 06/01/08 coromwEO SINGLE Lmnr <br />(Ea accidenq <br />f1, 000, 000 <br /> BODB.Y RJIURY <br />( Per person) <br /> HIRED AUi05 <br /> <br />NON OWNED AUTOS <br />BODD,Y INR1RY <br />(Per a~d~) <br /> PROPERN DAMAGE <br /> (Per accidenU <br /> GARAGE LNBq,ITY AUTO ONLY - EA ACCIDENT <br /> ANY AUTO <br />OTHER THAN EA ACC <br /> AUTO ONLY <br />AGG <br />B EYC ESS NMBRELLA LLeBD.rrY 621979673003 06/01/07 06 O1 0 EACH OCCURRENCE _ _ <br /> OCCUR ^ CLAMS MADE AGGREGATE E $ , 000, 000 <br /> <br /> ®DEDUCTIBLE <br />0 <br /> 00 <br />RETENTION $10, <br /> WORKERS COMPENSATION AND C STATU- OTH- <br /> EMPLOYERS' LIABH.TTY <br />E.L. EACH ACCB)ENT <br /> ANV PROPR~TOR/PARTNER/EXECUTIVE <br />OFFlCER/A~hIltER EXCLUDED? <br />E.L. DISEASE-EA EhBLOYEE <br /> If yes, describe under SPECIAL PkOY/SIONS <br />below E.L. DISEASE-POL]CY LLMT <br /> GrxER SEC IVED <br />DESCRB'IION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />C I ~ b /..._aZZ Divison Df Reclamation, <br />Minin and Safet <br />TTFI ~"TE HOLDER ~ ~ .~ ~ ~: ~ .::.' CEL 'ETON ~ ~ . ~:... <br />Mined Land Reclamation Di V, <br />1313 Sherman St, ROOM 21S <br />Denver CD 80203 USA sxouLD ANY Of THE AaovE DESCR®ED POLICIES BE CANCELLED BEFORE nIE ExPmAnoN <br />DATE THEREOF, THE ISSUING TNSl1RER WfIL ENDEAVOR TO MAIL <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />BUT FAILUkE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE INSURER, ITS AGEMS OR REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE e~f <br />s~9.e ~~ .S'eurccd @~ lexnd. 7.ac. <br /> <br />Y <br />W <br />.c <br />Y <br />.'O. <br />r <br />d <br />V <br />O <br />x <br />rn <br />v <br />v <br />m <br />m <br />N <br />M <br />N <br />O <br />O <br />n <br />N <br />0 <br />z <br />Y <br />Q <br />u <br />4_'. <br />Y <br />U <br />~_ <br />~_ <br />
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