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GENERAL44016
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GENERAL44016
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Last modified
8/24/2016 8:12:53 PM
Creation date
11/23/2007 12:46:49 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981025
IBM Index Class Name
General Documents
Doc Date
5/15/2002
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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acoRn CERTIFICATE OF LIABILITY INSURANCE DP ID DATE (MM/DD/YY) <br />EMCO-1 05/10/02 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Blanchard Insurance Group Inc. HOLDER. THIS CERTIFlCATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 60130 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Grand Junction CO 81506 ~~~fi/L <br />Phoae:9T0-245-8011 Fax:970-245-801 1 Y G INSURERS AFFORDING COVERAGE <br />INSURED INSURER A: Employers Mutual Casualty Co. <br />MAY 1 5 20 NSURER B: <br />$EM (,'Oa9tr11Ct i0II CO. INSURER C: <br />715 Horizon Drive, Suite 2~~lision of Minerals an pQy~ D; <br />Grand Junction CO 81506 <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED. NOTWRHSTANDING <br />ANV REQUIREMENT. TERM OR CONDRION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WNICM THIS CERTIFICATE MAV BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR TYPE OFINSURANCE POLICY NUMBER DATE MM/DD/YY DATE MID LIMBS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1, OOO, OOO <br />A X COMMERCIAL GENERAL LIABILITY 9X90868 05/10/02 05/10/03 FIRE DAMAGE (Any one rre) $ 100,000 <br /> CLAIMS MADE OCCUR MED EXP (Any one person) E 5,000 <br /> PERSONALSADV INJURY S1, OOO, OOO <br /> GENERAL AGGREGATE §2, DDD, DDD <br /> GEN'L AGGREGATE LIMRAPPLIES PER: PRODUCTS-COMP/OP AGG S2, DUD, DUG <br /> POLICY JEC~T LOC <br /> AU TOMOBILE LIABILITY <br />cOMBINEDSINGLELIMIr <br />a1, 000, 000 <br />A X ANVAUTO 9X90868 05/10/02 05/10/03 (Ee exitlent) <br /> ALL OW NED AUTOS <br />BODILY INJURY <br />§ <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS BODILY aJJUAY <br />§ <br /> X NON-OW NED AUTOS (Per eccitlent) <br /> PROPERTY DAMAGE <br /> <br />(Per ecddent) § <br /> GARAGE LUIBILITY AUTO ONLY-EA ACCIDENT S <br /> ANY AUTO OTHER THAN ~~ E <br /> AUTO ONLY: AGG E <br /> EXCESS LIABILRY EACH OCCURRENCE § <br /> OCCUR ~ CWMS MADE AGGREGATE $ <br /> S <br /> DEDUCTIBLE $ <br /> RETENTION S E <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br /> E.L. EACH ACCIDENT E <br />- - --_-~-~ -~- --- - -- -- -- - -E.CDIBEASE'EAEIr1PLOYE -§ --- <br /> E.L.DISEASE-POLICY LIMIT $ <br /> OTHER <br />DESCIVPTION OF OPERATIONSILOCATIONSNEHICLESrEXCLUSIONE ADDED BY ENDORSEMEM/SPECUIL PROVISION§ <br />Re: North Thamg~son Creek-File No C-81-025. State Of Colorado, Division Of <br />Minerals & Geology is included as aa'Additional Insured.*10 Days Notice due <br />to Noa-Payment Of Premium.**Or incur substantive changes or failure to <br />renew. <br />CERTIFICATE HOLDER I Y I ADDRIONAL INSURED: INSURER LETTER: A CANCELLATION <br />GGGGG GG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI <br />State Of COlOr8d0 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN <br />D1ViSi0a Of Minerals GeOlOgy NOTICE TO THE CERTIFlCATE HOLDER NAMEO TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />1313 Sherman Street ROOm 215 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, RS AG ENTS OR <br />Denver CO 80203 <br />REPRESENTATIVES. <br />ACORD 25-S (7/97) / ®ACORD CORPORATION 7988 <br />
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