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GENERAL43449
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GENERAL43449
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Entry Properties
Last modified
8/24/2016 8:12:13 PM
Creation date
11/23/2007 12:24:07 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981032
IBM Index Class Name
General Documents
Doc Date
5/17/1982
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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iiiiiiiiiiiiiiuiii <br />NAME AND ADDRESS OF AGENCY <br />ALEXANDER & ALEXANDER, INC. <br />2120 South 72nd Street <br />Omaha, Nebraska 68124 <br />NORTHERN COAL COMPANY <br />2223 Dodge Street <br />Omaha, Nebraska 68102 <br />COMPANIES AFFORDING COVERAGES <br /> THE TRAVELERS INDEMNITY COMPANY <br />COMPANY <br />LETTER A RHODE ISLAND <br />COMPANY <br />LETTER B THE TRAVELERS INDEMNITY COMPANY <br />COMPANY <br />LETTER <br />COMPANY <br />TER D <br />LET <br />COMPANY C <br />LETTER L <br />This is to certify that policies of insurance listed below have been issued [o the insured named above and are in force at this time. <br />NY PO <br />ICY Limits of Llabili in Thoucan s <br />:OMPA <br />LETTER TYPE Of INSURANCE POLICY NUMBER L <br />E%PIRATION DATE EACH gGGREGATE <br /> OCCURRENCE <br /> <br />A GENERAL LIABILITY <br />{ <br />TREE-NSL-133T873-A-82 <br />6-1-85 eoDlLr INJURY f 250 t 500 <br /> F <br />T <br /> LI COMPREHENSIVE FORM <br />®PREMISES-OPERATIONS ~~ ~~~~ <br />PROPERTY DAMAGE <br />f 2SO <br />S SOO <br /> ® EXPLOSION AND COLLAPSE <br /> HAZARD <br /> ®UNDERGROUND HAZARD <br /> <br />®POPER TSONSMHAZFRD ~p !T ~/ <br />11 <br />1 1 (]p <br />~ ~JO~ <br /> <br />® 1 <br />M 1 BODILY INJURY AND <br /> CONTRACTUAL INSURANCE PROPERTY DAMAGE f S 5OO <br /> RM PROPERTY <br />® BR COMBINED <br /> DAMAGE <br />^ INDEPENDENT CONTRACTORS MINED LA.N RECLAA~IAT1(I <br /> ® PERSONAL INJDRY Colo. Deft. OI :Lalu(al Re$at+t ~ <br /> PERSONAL IN JORY f <br /> road Form Vendors <br />' AUTOMOBILE LIABILITY BODILY INJURY <br />P <br />RSON <br />t 2SO <br />A COMPREHENSIVE FORM TREE-NSL-133T873-A-82 6-1-85 ) <br />(EACH <br />E s 250 <br /> OWNED (Texas Auto Only) BODILY INJURY <br />(EACH ACCIDENT) <br />B TR-CAP-162T813 <br />82 <br />0 PROPERTY DAMAGE t <br /> HIRED - <br />- <br /> (All Other States) BODILY INJURY ANp <br /> NON~OWNED <br />PROPERTY DAMAGE t <br /> COMBINED <br /> EXCESS LIABILITY <br /> <br />^ UMBRELLA FORM BODILY INJURY AND <br />f <br />f <br /> PROPERTY DAMAGE <br /> ^ OTHER THAN UMBRELLA COMBINED <br /> FORM <br /> WORKERS' COMPENSATION ~ srgruroar <br />A and TREE-UB-133T867-3-82 6-1-85 <br /> EMPLOYERS' LIABILITY t <br />IE4H ACUOf Mp <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES <br />Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- <br />pany will endeavor to mail 39- days written notice to the below named certificate holder, but failure to <br />mail such notice shall impose no obligation or liability of any kind upon the company. <br />NAME AND ADDRESS OF CERT IFICAi E HOLDER. <br />State of Colorado <br />Department of Natural Resources <br />Mined Land Reclamation Division <br />1313 Sherman Street <br />Denver, Colorado 80202 <br />PATE <br />5-12-82 is`ah <br /> <br />ORD 25 Intl n JT <br />
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