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GENERAL43865
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GENERAL43865
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Entry Properties
Last modified
8/24/2016 8:12:41 PM
Creation date
11/23/2007 12:40:36 PM
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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{{~~w /+~~/+pp~~~ <br />A` <br />O <br />~ <br />CER <br />IFI ~~ _ DATE (MM/DD/VYYY) <br />~ <br />lCLJ. <br />V <br />t T <br />: <br />CATE_OE LIABII :T TY TNSLTI2ANCE , <br />':'` .. ..... .... .a" 06/21/2007 <br />~ <br /> <br />PRODUCER <br />Aon Risk Services, inc of Florida THIS CERTIFICATE <br />IS ISSUED AS A MATTER OF INFORMATION ONLY <br />222 Lakeview Avenue AND CONFERS NO RIGHTS OPON THE CERTIFICATE HOLDER. THIS <br />Suite 510 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />west Palm Beach FL 33401 USA COVERAGE AFFORDED BY THE POLICIES BELOW. <br />PxoNe- 866 283-7122 FAx- 847 953-5390 INSURERS AFFORDBVG COVERAGE NAIC# <br />INSUREn wsuRER A: Pacific Indemnity Co 20346 w <br />OXBOW Carbon & Minerals LLC INSURER B: Westchester Fire Insurance CO 21121 .('-~" <br />1601 FOFUm pl <br />Attn: Donna 1. Gulbransen wsuRERC: Hartford Fire Insurance Co. 19682 v <br />west Palm Beach FL 33401-8101 u5A <br /> MSURER D: d <br />7 <br /> <br />: <br />~ INSURER E' <br />.> .. <br />: .. :..e .. .g <br />... <br />-: <br />THE POLICffiS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED i0 THE INSURED NAMID ABOVE FOR THE POLICY PERIOD AIDICATID. NOTWFFHSTANDING <br />ANY REQIIIREN~NT, TERM OR CONDTTION OF ANY CONTRACTOR OIHER DOCUMENT WTLH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY <br />PERTAIN, 11iE INSURANCE AFFORDED HY THE POLICIES DESCRBID HEREIN IS SUBIECT TO ALL THE TERMS, EXCLUSIONS AND CONDTDONS OF SUCH POLICIES. <br />AGGREGAIE LIIMTTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR D' <br />DiSR <br />TYPE OF DSURANCE <br />POLICY NUMBER POWCY'EFFE POLCY EXPIRATION <br />LIMITS <br /> DATE(MM\DD\W) DATE(MM\DD\WI <br />A ERAL LIABR.ITY 35863379 06/01/07 06/01/08 EACx occuRRENCE $1,000,000 <br /> X COMMERCIAL GENERAL LIABD.FfY DAMAGE TO RENTED $1,000,000 <br /> GL PREMISES (Fs oceurence) <br /> AG1$MADE ® OCCUR EXP (MV Doer pe[5oN <br /> <br /> PERSONAL&ADV INNRY 51 <br />000,000 ,~-~ <br /> , C <br /> GENERAL AGGREGATE $2 <br />000 <br />000 M <br /> GEN1 AGGREGATE LP11T APPLIES PEA , <br />, ^~ <br /> : <br /> <br />^ POLICY ^ <br />^ LOC PRODUCTS-COMP/OP AGO 52,000,000 N <br />G <br /> ~~ O <br /> <br />C AD' romoaH.E LUnarrY 20uENZQ6228 06/01/07 06/01/08 <br /> COMBINED SMGLE LGOT <br /> X ANY AUTO Os eadem> E1,000, 000 z <br /> ALL OWNED AUTOS d <br /> BODn,Y MRJRY W <br /> SCHEDULED AUTOS (Per person) ~ <br />4' <br /> HntED AUTOS <br /> BODD.Y N`NRY u <br /> NON OWNED AUTOS (Per azddws) U <br /> PROPERTY DAMAGE <br /> (P<e vuidens) <br /> GARAGE LIABD.ITY AUTO ONLY - EA ACCD)ENT <br /> e ANY AUTO <br />OTHER THAN EA ACC <br /> AUTO ONLY <br /> AGG <br />B excess iUMeRecu LUnarrv 621979673003 06/01/07 06 O1 08 EACH OCCURRENCE <br /> p'OCCOR-~"CLAA1SRTADH- GGREGAIE~ ---~-SS:000~000 -~ <br /> <br /> DEDUCTIHLE <br /> ® <br />$10 <br />000 <br /> . <br />RETENTION <br /> WORKERS COMPENSATION AND <br /> <br />' <br />C STATU- OTH- <br /> EMPLOYERS <br />LIABH.ITY <br />E.L. EACH ACCD)EM <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> _ <br /> OFFICER/h~MBER EXCLUDED? E L. DISEASE-EA EMPLOYEE <br /> Ifyes, describe undo SPECIAL PROVISIONS IS E-POLICY LIMIT <br /> below <br />Fl <br /> <br /> GTHER JUN 5 2007 <br /> <br />DESCRIPTION OF OPERATIONS/LOCAi10NS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEA~MISPECIAL PROVISIONS eC afllatlOn <br /> <br />L' - j ~j d ~ -OZZ , <br />Mining and Safety <br />"'" <br />CERT TE IIOLbE ~ ' >: : <br />C LLATd©N . "-:: ; .:.: ";: .. <br />"~" "" <br />O1 Vl5l On Of Ml nerdl5 & Geology SHOULD ANY OF THE ABOVE DESCRBED POLICES BE CANCELLED BEFORE THE EXPBRATION ~ <br />Attn: Bill carter DATE THEREOF, THE ISSUWG INSURER WILL ENDEAVOR TO MAIL <br />1313 Sherman Street, ROOM 21S 30 DAYS WRFI"FEN NOTICE TO THE CERTIFlCATE HOLDER NAMED TO THE LEPT. <br />Denver CO HOZO3 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILRY <br /> OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />tr <br /> AUTHORIZED REPRESENTATIVE <br />" <br />' <br />` <br />' <br /> J'S{ua <br />/~ <br />~s .S <br />i2arCEa e~j <br />~exad. %.sc. <br />>.:::. _<:. nco;~ccixroxnT~olviisa ~ <br />
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