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~1 <br />R`TIFICATE OF INSURANCE lasuE DAtE IYMiDD+' <br />2/12/87 <br />DDUCER TNIi CERTIFICATE K raWED K A a1ATTER Of WFOIIYATIDIi OMLT AND CONFERL <br />110 aaONTi UPON THE CERTFMATE NOIDER. TNit CERTIFICATE DOEt NOT AMEND. <br />MBnh 6 McLennan, Incorporated BXTEND OR ALTER THE COYERAOE AFFORDED BY t?IE IouC10 B[lOw. <br />Throe EmWruderD Center COMPANIES AFFORDING COVERAGE <br />San Francisco, CA 94111 <br /> COYPANr <br />A <br /> LETTER INSURANCE COMPANY OF NORTH AMERICA <br /> COMPAHr <br />S <br /> LETTER PACIFIC EMPLOYERS INSURANCE COMPANY <br />sURED <br />TTTSBURC 6 MDWAY COAL !D'NINC CO. COYPANr <br />C <br />720 SOUTH BELLAIRE STREF:f LETTER INA OF TEXAS <br />ENVER <br />CO 8 <br />222 <br />, <br />0 <br /> COMPANY <br /> LETTER <br /> COMPANY <br /> LETTER <br />ERADES <br />TNIa R TD CERTI-r TX-T POLECIE; OF INWRANCE LJaTED BF10w NAPE BEEN rt1UED TO THE RFW RED MWED ABOVE i011 THE F'OUCr -ERIOD WDICATED. <br />R17iMTTNiTANDINO ANY REOUIREYEM, TERM OR CONDITION OF ANT CONTMR OR OTNFR DOCW FNT WRN REiPECT TO WNICN TNK CERnflCATE YAr <br />/E IaSUFD OR YAT FY RTAIN. Tl1E INWRANCE AFFORDED BT THE 19LICIFJi D3:RIBED NEAEIN K WBJER TO ALL THE 1ErYEi. QCLYagNa, AND CONDF <br />T10NS OF WCN P'OIJCIE6 <br /> 1'OLCr' ETTECI NE FDILY ERPalATE11 LIABILm UYITb IN TNOUiANDi <br />TY-E OF INSURANCE POLICY NUMBER ptTE RaAOOMri WTE M1EL00nry AGGAEWTE <br />[ <br /> OCCUR <br />~CF <br />G ENERAL LW ILm B7fiLT <br />X tOaaR1EIENSNE FORM aUUIT <br /> PR4Y6ES A7ERATD16 HDC GO 895580-A 3/1/87 3/1 /BB <br />"° <br />P47 <br />"r <br />= _ <br /> tPpFRcRDUn a <br />W <br />~ <br /> DIPLOSiYI a OTLIA^'S[ NALIRD <br /> <br /> PrOpIL'TSRdiLETED DPERAross <br />X mNIRAnDai ~~ S 300 S 500 <br /> B[FPESEENI [DNiMRDRS <br /> BNxoR71W PROPEpTr o~WeE <br /> PEItTONEl BUURT PERSOIML aUtRr <br /> AVTOYOBII[ LIABILFTY ~; %( . <br /> s <br /> aw auto ~"'s'~"~ <br /> Ail Oq'IED aurps MlN PA55) ROOLL~ <br />Rl+t• ~°` <br />S <br /> 41 INrIED a1JID5 f071ER TNRN A^ •CO[N <br /> KiN. PASSI <br />NRTD AU105 <br />IIOP£RrT <br /> <br />: <br /> ROMOR'IED AUfDS ~ DAWGE ,. <br /> <br /> 6:;,:r<Lrsarr ^~t~ § <br />ExcFas uASnm <br />useRELU FORM B~roj(p = s <br />trt~Fa tRAN IA®RELU waY <br /> tiAt~On <br />q SMORKERS' COYPENiAT10M C2850774~ (New Jersey) S 1 ~OTACM ACLOf1711 <br />g AND 02850773.2 (Kansas) <br />7 <br />3/1 B8 S 1 OOQ~~~In iaaTl <br />[YrLOrERS•LUtllm C285D769-0 (All Other States) 3/1B 5E{ADI EYPIOrEEi <br />S 1,ooomsLA <br />B C2850771~ (California) <br />C 02650772-0 (Texas & Oklahoma) <br />DESCRIPTION OF OPERATIONS+LOCATIONSNENICLESI6PE^JAL ITEMS ~. IDNA HINE <br />ISSIIINC COlffANY SBALL NOTIFY TFQ: BELOW HAlfID CERTIFICATE HOLDER <br />7EIEtlBVER SUBSTANIIVE CHANCES ARE HARE IH ~ ABOVE DESCRIBID POLICY INCLUDING <br />F3UfINA1TON OR FAII,URE TO RENEW, <br />:RTIFICATE HOLDER CANCELLATION <br />BND::ID ANT OF THE ABOVE DESCRIBED P'OLICIEi BE CANCELLED BEFORE THE EX~ <br />AVID SHELTON PIRATIOy DATE THEREOF, THE IiSUINO COMPANY WILL ENDFJIVOR TO <br />EPART!>ENT OF N/1T[IRAL RESOURCES MAIL :i0 DAra W RlTTEN NOTICE TO TIIE CERTIFICATE MOLDER N W ED TO THE <br />313 SHF7UlAN S1REl:T tEF'T, BUT FAILURE TD YAII WCN NOTICE BNALL IYPOiE NO OaLWATiON OR LIA6ILF <br />Tf OF ANT KIND UPON THE COYPANr, tTf AOE11T5 OR REFRESENTATiVES <br />F]NER, CO 80203 <br />~+IfH(lAi)F!1 RFRRF SE NT AT+VF <br />I <br />./ <br />