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GENERAL43516
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GENERAL43516
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Entry Properties
Last modified
8/24/2016 8:12:15 PM
Creation date
11/23/2007 12:26:24 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1996084
IBM Index Class Name
General Documents
Doc Date
9/12/1997
Doc Name
CERTIFICATE OF LIABILITY INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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I I I I I I I II IIII II I <br /> <br />t <br />1 DATE (MM/DDM7 <br />IT <br />E <br />Y:INSURANC <br />FICATE. ©~ LIABI <br />999 .. rERT <br />::Race f oF..::.1:: 9-9EP-,997 <br />~PpooucER 79100 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Willis Corroon Corporation of Birmingham ONLY AND CONFERS NO RIGHTS UPON THE CERTIFCATE <br />1927 First Ave. North HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 11587 (35202) RECEIVED ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW. <br />Birmingham AL 35203 COMPANIES AFFORDING COVERAGE <br />(205) 323-7000 <br /> <br />SCSI ~ 2 ~^~~ <br />Betty Hollis Lf JU National Union Fira Ins. Co. of Pittsburgh, PA <br />COMAPANY <br />INSURED COMPANY <br />1ivlsi0n of wnneral <br />G 9 <br />s 6 <br />eology <br />Lorencito Coal Company, LLC COMPANY <br />1311 B <br />t <br />i <br />d D C <br />woo <br />r <br />ve <br />en <br />Evansville IN 47711 COMPANY <br /> D <br />~:COVERAGES~:: ~. :.':' .......:'~'~: .':': ~ ~ .. . , . .. .. .. <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAV BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJ EOT TO ALL THE TERMS, <br />MS. <br />E%CLUSIONS AND CONDITIONS OF SUCH POLICIES. UMI73 SHOWN MAY HAVE BEEN REDUCED By PAID CLAI <br />~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE T <br />POLICY E%PIRATIONI LIMnS <br />LTR DATE (MNIDD/V'/) DATE (MM/DD/YY) <br />A GENERAL LIABILITY GL5652470RA 24JAN-1997 24JAN-1998 pENERAL AGGREGATE 5 2,000.000 <br /> X COMMERCIAL GENERAL LIABILITY PROOUCTSCOMPIOP AGG S 5,000, OOO <br /> CLAIMS MADE ~ OCCUR PERSONALb AOV IWURY S S • OOO • OOO <br /> OWNER'36 CONTRACTOR'S PROT EACH OCCURRENCE f 1.000,000 <br /> FlRE DAMAGE (Any one lire S 50.000 <br /> MED EXP An one non 5,000 <br /> AUT OMOBILE LABILITY COMBINED SINGLE LIMIT f <br /> ANY AUTO <br /> <br /> ALL OWNED AUTOS BODILY INJURY f <br /> (Per person) <br /> SCHEDULED AUTOS <br /> <br /> HIRED AUTOS BODILYIWURV S <br /> NON-0W NED AUTOS (Per acctlanq <br /> <br /> PROPERTY DAMAGE <br /> S <br /> GA RAGE WBILITY AUTOONLV ~EA ACCIDENT S <br /> <br /> ANV AUTO OTHER THAN AUTO ONLY <br /> <br /> EACH ACCIDENT S <br /> AGGREGATE <br /> E%CESS WBILffY EACH OCCURRENCE S <br /> ~ <br /> UMBRELU FORM AGGREGATE S <br /> <br /> OTHER THAN UMBRELLA FORM <br /> I <br />ORH~ <br />TT <br />L <br /> WORNER9 COMPENSATION AND { MITS <br />ORY <br /> <br />ENPLOYERS'LIABIUTY I <br />EL EACH ACCIDENT - <br />f <br /> THE PROPRIETOR/ <br />R <br />R <br />P <br />E <br />EC <br />INCL <br />EL OiSEA36POLICY LIMIT <br />S <br /> A <br />TNE <br />% <br />UTI VE <br />S/ <br /> OFFlCERS ARE E%CL EL DISEASE-EA EMPLOYEE <br /> OTHER <br />OESCRIPTKIN OF OPERATIONS/LOCATIOMS/VEHICLES/SPECUL ITEMS <br />RE: Permit No. C-96-084 Location: 2 miles West of Segundo, CO. on Highway 12 <br />~CERTffICATE'NOLDER .:.:: .::.; :~~~~ ::.' :.' CANCELLATION ~.. .. .. <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />Colorado Division of Minerals and Geology 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />1313 Sharman Street BUT FAILURE TO NAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />Room 215 OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATNES. <br />Denver CO SO2O3 <br />-'v. <br />AUTH ED REPRESENT VE ~ / - <br />ACORD 25 9 F1I9S) :: ~ ~ ~:VARIOU52 ~ !,_ .::__ :..: :. ~ ~. <br />: '~ ACORD CORPORATION 1988. ~:~ <br />
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