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III IIIIIIIIIIIIIIII 1~6-~ <br />SackmaTi/Western Service Agency <br />1225 N. Grand Suite 206 <br />Pueblo CO 81003 <br />INSURED <br />Blue Flame Coal, Inc. <br />dba Blue Flame Coal Mine <br />1001 East 2nd Ave. <br />HTlrango Co 81301 <br />THLs CERTIFCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS <br />NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, <br />E%TEND OR ALTER THE COVERAGE AFFORDED BY THE POl1CIES BELOW. <br />COMPANIES AFFORDING COVERAGE <br />-...• <br />LETTER V A B1tU1DinOU9 ~.•':'~._.~. ~~.I ~.';: • <br />COMPANY <br />LETTER B I <br />LETTERNY C <br />COMPANY D - ~ ~~~~ r - ~-~- ~~ "' <br />LETTER . `(!' ... .. ~ . . <br />COMPANY E <br />LETTER <br />THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN DiSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWfiHSTANDINGRNY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WHICH THI9 CERTIFICATE MAY <br />BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIdES DESCRIBED XEREIN IS SUBJECT i0 ALL THE TERMS, EXCLUSIONS, AND CONDI- <br />TIONS OF SUCH POLICIES. <br />CO <br />TYPE OF INSUR <br />E PDLICY EFFECTIVE PoLICr EI(RMTIGY LIABILITY LIMBS IN THOUSANDS <br />L ANC POLICY NUMBER DATE IMMmo~n1 BATE (MMDNYYI EACH <br />AGGREGATE <br /> OCCURREN <br /> G ENERAL LIABILITY <br />PADILY <br />IWURY <br />~ <br />$, <br /> X CDMPREHENSNE FDRM <br />A A PREMISES/DPERAl10NS pgOPER1V <br />GE ' <br /> UNDERGRDU <br />ExPLOSION* 18-62 <br />14 <br />GLA 6-4-86 6-4-87 DAMA <br /> X PRDDUCTS/COMPLETED OPERATIONS - <br />- <br /> CONTRACTUAL COMB NED $ 5GQ $ 5OO '~ <br /> X INDEPENDENT CONTRACTORS <br /> BROAD FGRM PROPERTY DAMAGE <br /> PERSONAL INJURY PERSONAL INJURY <br /> A UTOMOBILE LIABILITY IA~AIRri $ :,.;;t N- <br /> ANY AUTO FHI VF0.ad1 <br />Z~ <br /> ALL OWNED AUTOS (PRN. PASS.) ®ULr .,;. irt4= <br /> <br />~. /oTHER THAN <br />ALL OWNED AUTOS t PRIV <br />PASS. ~ NIAN <br />~ NnDBITI .xpC,. <br /> <br />~ <br />. .. <br /> . ~ <br />" <br /> HIRED AUTOS PROPERTY <br />$ '. `3;' <br />:`:;~,! <br /> NON-0WNED AUTOS DAMAGE .,..f. - 4 <br /> <br /> GARAGE LIABILffY BI 8 PD <br />COMBINEO <br />~ ~~~~ ~ ._ <br />',##Ra''iy~' ~ "~ <br />° <br />~ <br /> .`> <br />' <br />'- <br />' ExCESS LWBllrrr <br /> UMBRELLA FORM BI 6 PD <br />COMBINED <br /> DRIER THAN UMBRELLA FORM ~ <br /> <br />WORKEgS' COMPEN <br />ATION STATUTORY ,~^;;.,$', t ~} . <br /> S ~~:.^` $ (EACH ACCIDENT) <br /> AND <br />' <br />~ (DISEASE~PoLICY LIMIn ' <br /> EMPLOYERS <br />LIABILITY - <br />'t; <br /> ~ $ (DISEASE~EACH EMPLOYEE) <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS <br />Coal Mining <br />Peter O'Conner <br />Mine Land Reclamation, Div,. <br />423 Centennial Building <br />1313 Sherman <br />Denver CO 80203 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- <br />PIRATU~~ DATE THEREOF, TXE ISSUING COMPANY WILL ENDEAVOR TO <br />MAILDAYS WFITTTEN NOTICE TO THE CERTIFCATE XOLDER NAMED TO THE <br />LEFT, BUf FAILU MAIL SUCH NOTICE SHALL IMPOSE NO OByGATION OR LUU3ILTTY <br />OF ANY KI COMPANY. LTS AGENT~~REPRE~MTTATIVES. <br /> <br />