GENERAL48677

• Permit No: C1981016
• IBM Index Class Name: General Documents
• Doc Date: 9/4/1990
• Doc Name: FAX COVER
• From: MOUNTAIN REGION CORP
• To: MLRD
• Permit Index Doc Type: RECLAMATION PROJECTS
• Media Type: D
• Archive: No

NAMED INSURED: MOUNTAIN REGION CORPORATION
POLICY NUMBER: GSP003104 COMMERCIAL GENERAL LIABILITY
EFFECTIVE DATE: 11/14/90 - 11/14/91
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-OWNERS, LESSEES or
CONTRACTORS (Form A)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Mama of Person or Organization (Additional Insured):
THE STATE OF COLORADO/MINED LAND RECLAMATION
1313 SHERNAN STREET, ROOM 215
- -DENVER, CO 80203 - - - - - - - -
Premlum Basis Rates
Bodily Injury and (Per
Property Damage Liability Cost 51000 of cost)
;I,000,OOO.OO PER OCCURRENT ANY SUBJECT TO AUDIT
Total Advance Premium
Location of
Covered Operations
OPERPTIONS OF THE tL4MED INSURED
S
S
Advance Premium
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
1. WHO IS AN INSURED (Section II) is amended to (a) All work on the project (other than
include as an insured the person or organization service, maintenance. or repairs) to
(called "additional insured") shown in the Sched• be performed by or on behalf of the
ule but only with respect to Inability arising out ot: additional insureds) at the site of the
A. "your work" for the additional insureds) at covered operations has been com-
the location designated above, or pleted; or
B. Acts or omissions of the additional insureds) (b) That portion of "your work" out of
in connection with their general supervision which the injury or damage arises has
of "your work" at the location shown in the been put to its intended use by any
Schedule. person or organization other than an-
other contractor or subcontractor
2. With respect to the insurance afforded these addi- engaged in performing operations for
tionalinsureds.thefollowingadditionalprovisions a principal as a part of the same
apply' - - - - - Project. - -
A. None of the exclusions under Coverage A, (3) "Bodily injury" or "property damage"
except exclusions (a). (d), (e). (f), (h2), (i), arising out of any act or omission of the
and (m), apply to this insurance. additional insureds) or any of their em-
B. Additional Exclusions. This insurance does ployees, other than the general supervi-
not apply to: sion of work performed for the additional
(1) "Bodily injury" or "property damage"
insureds) by you.
for which the additnonal insureds) are (4) "Property damage" to:
obligated to pay damages by reason of (a) Property owned, used or occupied by
the assumption of liabilrty in a contract or or rented to the additional insured(s);
agreement. This exclusion does not apply
to liability for damages that the additional
(b) Property in the care, custody, or con-
insured(s) would have in the absence of trot of the additionalinsured(s) or
the contract or agreement. over which the additional insureds)
are for any purpose exercising phys-
2 "Bodrl in ur " or " ro ert dama e"
( ) Y 1 Y P P Y g ical control; or
occurring q~lter:
(c) "Your work" for the additional in-
sured(s).
CG 20 09 11 85 Copyright. Insurance Services Office. Inc., 1984 ^