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GENERAL43021
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GENERAL43021
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Last modified
8/24/2016 8:11:47 PM
Creation date
11/23/2007 12:07:41 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1983059
IBM Index Class Name
General Documents
Doc Date
7/10/2006
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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AGUKU,w CERTIFICATE OF LIABILIT Y INSURANCE of/o6/os <br />PROOaiieR <br />Aon Risk services, Inc of Florida THIS CERTIFICATE IS IS, A' nIATTER OF INFORMATION ONLY <br />222 Lakeview Avenue AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />Suite 510 ~ CERTIFICATE DOES NOT A61 ~~,~aFs~G?~;~PAY ALTER THF, <br />~ <br />west Palm Beach FL 33401 USA COVERAGE AFFORD@~If\9~ry ~'HE POLICIES BELOW. <br />Pnone~ 866 283-7124 FAx- 866 430-1035 INSURERS AFFORUINC COVERAGE <br />INSUaeD INSURER A: American International Specialty Lines <br />oxbow Carbon & Minerals LLC INSUaEae Hartford Fire Insurance Co. <br />1601 Forum P1 <br />Attn: DGnna J. Gul brdn5e0 INSURER Ct Federdl InsH rdnCe COmpdOy i <br />West Palm Beach FL 33401-8101 USA <br /> <br /> INSURER D: Westchester surplus Lines Ins Co <br />`e <br /> m <br /> INSURER E~ <br />COVERAGES This Certificate is not intended to s ecify al6endorsemen(s, coves es, terms conditions and exclusions of the policies shown. SIR May App y `e <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ENSURED NAMED ABOVE FOR 7HE POLICY PERIOD INDICATED, NOTWITHSTANDMG S <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH PHIS CERTIFICATE MAY BE ISSUED OR MAY ~ <br />S <br />PERTARN, THE MSURANCE AFFORDCD BY THE POLICIES DESCRIBED HEREI N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />~ POLICY EFFECTIVE POLICY EXPIRATION <br />LIMITS <br />'r <br /> ` DATE(MM\DD\YY) DATE(MM\DD\YYI <br />C GENEML UAeIUrv--~. - _~ 3586337_9,,. _.,,,~:,. .~ ~_ <br />i <br />l' <br />i ,06[01/06.,. . 06[01/n7 _ EACH OCCURRENCE. -_ ~.-E3, 000, 000 „^,. <br /> <br />X <br />COMMERCIAL GENERAL LIABILITY l <br />Genera <br />Li ab <br />ty <br />/ <br />FIRE DAMAGE(Anv one fire) <br />51,000,000 rt <br />~ <br /> CLAIMS MADE X^OCCUR MED EXP (Anv one ocrsonl E10, 000 C <br />n <br /> ~ PE0.50NAL& ADV MIURY $1,000,000 <br /> / GENERAL AGGREGATE $2,000,000 <br /> ' ~ ' <br /> GEN <br />L AGGREGATE hIMIT APPLIES PER. <br /> PRO <br />~ ~ r PRODUCTS-COMP/OP AGG $2,000,000 <br /> POLICY <br />IECT LOC z <br /> <br />a <br />a <br />B A urohwalLe laAen.ITV 20UEN2Q6228 09/01/0$ 09/01/06 <br />COMBINED SINGLE LIMIT <br />4' <br /> ' BDS 10855 AUtORIObIIe (ES:.cddem) 51,000,000 <br /> X ANY AUTO ~ <br /> ALLOWNF.D AUTOS ~ BODILI'hWURY ~ <br /> SCHEDULED AUTOS ~ ~~w ED (Ya person) i <br /> HIRED AUTOS ~ RE fSODILY IryIURV <br /> NON OWNED AUTOS 2005 IPe azcidrn0 . <br /> ,u` ~ X PROPERTY DAMAGE <br /> Per ac <br />id <br />Q <br /> ( <br />c <br />en <br /> G <br /> GARAGE LIABILITY DINBbD D1 M\081 AUTO ONLY - EA ACCIDENT <br /> ANY AUTO <br />OTHER THAN EA ACC <br /> AUTO ONLY <br /> AGG <br />D EXCESS LIAmuTV G 1 796730 <br />ll <br />ili <br />b <br />i 06/01/06 06 O1 7 EACe OCCURRENCE 525,000,000 <br /> <br />- <br />X OCCUR ^ BINS MADE um <br />re <br />a L <br />ab <br />ty <br />_-~_ 4~ ~ ,_ _ , _„ ~ <br />- <br />___ Y _--, <br />_ _^ - __ ~~ <br />AGGREGATE <br />$2$,000,000 <br /> <br /> DEDUCTIBLE <br /> X RETENTION $IO, OOO <br /> <br />wORKER5COh1PENSATIONAND WC $TATV- OTH- <br /> <br />EMPLOYER <br />IABI <br />' TORY LIMITS ER <br /> S <br />L <br />LITY <br />E.L. EACH ACCIDENT <br /> <br /> E L DISEASE-POLICY LIMIT <br /> DISEASE <br />EA EMPLOYEE <br />E L <br /> . <br />- i.. <br />A Oixea PL59528238 09/29/03 09/29/06 Limit (T) $50,000,000 <br /> <br />X poll Legal Li ab Pollution Legal Liability ~L <br />'~1 <br /> <br />DESCftIPT10N OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS y l <br />RE: Terror creek company. c-1983-059 <br />Commercial General Liability covers use of explosives. a <br />Division of Minerals & Geology is named as an Additional Insured excluding workers' Compensation and Employers' .~3e <br />CERTIFICATE HOLDER ~ CANCELLATION `~ <br /> <br />D1 Vl SlOn Of Mi ^erd15 & Geology SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRATION <br />1313 Sherman street, ROOM 21S DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVDR TO MAIL yk <br />Denver CO 80203 u5A 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br /> <br />Y ~ <br /> ~1 <br /> AUTHORIZED REPRESENTATI VE ~ ~ ~~///! q <br />!!GCI....a~-Y_F-4..i- <br />1 ACORD 25-5 !7/971 - - ACORD CORPORATION 19881 ~ <br />
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