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GENERAL46714
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GENERAL46714
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Entry Properties
Last modified
8/24/2016 8:20:56 PM
Creation date
11/23/2007 2:52:05 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981022
IBM Index Class Name
General Documents
Doc Date
9/7/2007
Doc Name
Certificate of Liability
To
DRMS
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD <br />~ O r ~ <br />,r <br />~ ~ <br />~» ,„~: 09/0~/0~ <br />PRODUCER <br />AOn Risk servi Ces, IDC Of Fl Orldd THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />222 Lakeview Avenue AND CONFERS NO RIGHTS UPON 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 />PHONE- 866 283-7122 FAX- 847 95 - INSURERS AFFORDING COVERAGE <br />INSUaeD SURER n: Twin Ci [y Fire InBUranCe Company <br />Oxbow Mining LLC <br />INSURER B: Federal Insurance Company <br />1601 Forum P1 <br />We St Pdlm Beach FL 33401-8101 USA SEP 7 200 R <br /> 0 INSURE <br />C: ~ <br /> L <br /> MSURER D: <br />.~ <br />Qivisi0n of Reclama ' <br /> RFR E: D <br />.I <br />~OVERAGES'"~+Ttiis Certificate:is!noE.intehdedfo-5 eci ''2. 'eS•'temiS ~.cundition3=add~ezclusions of the liciessli6wn '~~~'- <br /> <br />~ '- <br />w <br />THE POLICIES OF MSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDMG 9 <br />ANY ftEQU1REMENT, TERM OR CONDITION OF ANY CONTRACTO R OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY ~ <br />PERTAM, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREM IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSN <br />LTR <br />TYPE OF IN3HRANCE <br />POLICi'NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br />LIMITS <br />m <br /> DATE(M1IM\DD\YY7 DATEINIM\OD\YY) 0 <br />N <br />B GENERAL LIABILITV 37107765 <br />G <br />l <br />i <br />bili 09/01/07 09/01/08 EACH OCCURRENCE $1,000,000 c <br /> <br />X <br />COMMERCIAL GENERAL LIABILITY enera <br />L <br />a <br />ty <br />FIRE DAMAGEIMVOne Ere? <br />E1, OOO, DDD m <br />rv <br /> CLNMS MADE ^X OCCUR MED EXP(Myow personl ESO, 000 O <br />r <br /> PERSONAL&ADV INJURY $1,000,000 ~ <br /> GENERAL AGGREGATE $2 <br />000 <br />000 <br /> , <br />, <br /> GEN'L AGGRCGATE LIMIT APPLIES PER: <br /> PRO- <br />X <br />~ <br />~ PRODUCTS-COMP/UP AGG $j, QDO, 000 <br /> POLICY <br />LOC <br />IECT z <br /> '- W <br /> w <br />A AUTOMOBILE LIABILITt' 20UENZ06230 09/41/07 09/D1/OS CYIMBMED SINGLE LIMIT !~ <br /> Business Automobile (Ea acclaem) E1, 000,000 <br />. <br />^ <br /> X ANY AUTO ` <br />~ <br /> ALL OWNED AUTOS BODILY INURY U <br /> SCHEDULED AUTOS (Pa perwn) <br /> X HIRED AUTOS BODILY INJURY <br /> NON O WNED AUTOS (Per acc0en0 <br /> PROPERTY DAMAGE <br /> (Pa pcpidw0 <br /> <br /> GARAGE LIABILITY AUTOONLY - EA ACCIDENT <br /> ANY nUTO OTHER THAN EA ACC <br /> AUTO ONLY: <br /> AGG <br /> EXCESS LIABILITY EACH OCCURRENC[ <br /> OCCUR ~ CLAIMS MADL AGGREGATE <br /> <br /> DEDUCTlHLE <br /> RETENTION <br /> <br />WORKERBCOMPENSATIONANU <br />' WC STATU- OTH- <br />T RY LIMITS ER <br /> EMPLOYERS <br />LIABILITY <br />E.L. EACH ACCIDENT <br />- <br /> E.L. DISEA56POLICY LIMIT <br /> E.L. DISEASE-EA EMPLOYEE <br /> <br /> OTHER <br /> <br />DESCRIPTION OF OPERATIONSILOCATIONS/VCHICLESILXCLUSIONSADDED BV GN WRSEMENTISPECIAL PROVISIONS <br />Re: Elk Creek Ml ne, Permit #1981-022 <br /> <br />ERTIFICATE HOLDER - - CA CELLATION - - - <br /> <br />DI VI SIOn of Reclamation, Mining SHOULD ANY OF THE ABOVC DESCRIBED POLICIES BE CANCELLED BEFORE TN[E%PIRATION <br />and safety DATB THERLOF, THE IySUMG COMPANY WILL ENDEAVBIFTB MAIL <br />1313 Sherman Street, ROOM 215 10 DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />Denver CO 80203 USA <br /> AUTHORIZED REPRESENTATIVG _~/.V /,. /,~,~_,i, <br />[ e(/ <br />Y <br />s <br />,a <br />ACORD'25-5 ~f7/97S ~. :'~. ~ .;:;:,_,- -.. ,. T <br />^. ' <br />- _ _ .. _ ~ ._:'.' = <br />
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