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GENERAL48814
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GENERAL48814
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Entry Properties
Last modified
8/24/2016 8:25:55 PM
Creation date
11/23/2007 4:35:09 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1989074
IBM Index Class Name
General Documents
Doc Date
7/12/2005
Doc Name
Certificate of Liability Insurance
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD <br />CERTIFICATE OF LIABILITY INSURANCE o;; <br />n <br />PaQe 1 cf 2 0„ <br />2QQ5 <br />PRODUCEfl 877-945-7378 THIS CERTIFlCATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Willis North America, Inc. -Regional Cert seater HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />26 century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />P. O. Box 305191 <br />Nashville, TN 372305191 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED American Civil Coaetructore, IBC. INSURER A: Arch Ia811raace COmyeay 11150-001 <br />Divleioa 201 attn Arlene RECEIVED <br />1601 went Belleviea Ave INSURER B: National Onion Fire Ins. Co. of Pittsburg 19445-001 <br /> <br />Littleton, CO 80120 INSURER C: <br />I INSURER D: <br />I <br />I ~ ~ 2005 <br />r-I-'I- INSURERS <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE $$~~~j QQid6M$BIppED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANV RE <br />UIREMENT <br />TER <br />~R <br />4CT OR <br />H <br />Q <br />, <br />M OR CONDITION OF AN1 <br />. <br />OTHER DOCUMENT WITH RESPECT TO W <br />ICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOW N MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD' IYPE OFINSURANCE POLICY NUMBEfl POLICY EFFECTIVE POLICY EXPIRATION LIMBS <br />A GENERAL LIABILITY 71PXG2 026401 7/l/ZOOS 7/1/2006 EACH OCCURRENCE _ $ 2 QQQ OQO <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Beaaorence $ 300 000 <br /> CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ S QQQ <br /> PERSONALS ADVINJURY $ 2 OOO QQQ <br /> GENERALAGGREGATE $ 4 QQQ QQQ <br /> GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $ 4 OOO OOO <br /> POLICY PRp LOC <br />A AUT OMOBILE LIABILITY 71PRG2026401 7/1/2QQS 7~1~2006 COMBINED SINGLE LIMIT <br /> (Ea acciden0 $ l~QQQr OOO <br /> X ANYAUTO <br /> ALLOWNEOAUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Par person) $ <br /> HIRED AUTOS <br />BODILY INJURY <br />$ <br /> NON-OWNED AUTOS (Peramitlen0 <br /> PROPERTY DAMAGE <br /> <br />P <br />id $ <br /> ( <br />er acc <br />ent) <br /> GARAGE UABIUTY AUTOONLY-EAACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTOONLY: AGG $ <br />$ E%CESS LIABILITY BE4953306 7/1/2QQS 7/1/2006 EACH OCCURRENCE $ 5 QQQ pp0 <br /> <br /> X OCCUR ~ CLAIMS MADE AGGREGATE $ S OOO OOO <br /> <br /> DEDUCTIBLE $ <br /> X RETENTION $ lO QQ $ <br />A WORKERS COMPENSATION AND <br />' 71WC22026301 7/1/2005 7/1/2006 X WC STATIU- OTH- <br /> EMPLOYERS <br />LIABILITY <br /> ANV PROPRIETOIUPARTNERrD(ECUTIVE - - E.L. EACH ACCIDEM $ 1 QQQ QQQ <br /> OFFICER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $ 1 QQQ QQQ <br /> Eyes, describe under <br /> SPECIAL PROVISIONSIxIOw E. L. DISEASE-POLICY LIMB $ S OOO OOO <br /> OTHER <br />DESCRIPTION OF OPERATONS/LOCATIONSNEHICLESIE%CLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />Re: Permit #C89-074 <br />Certificate Holder is named as Additional Insured on the General Liability per the attached <br />endorsement. Additional endorsements attached are applicable only as required by written contract <br />SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INBURER WILL L37D7Il~CXX-C MAIL 3Q DAYS WRITTEN <br />NOTICE TO THE CERTIFlCATE HOLDER NAMED TO THE LE L <br />Colorado Division of Minerals sad Geology M~ltBeeo~]UIFaA <br />1313 Sharman, ROOK 215 AUTHORIZED REPRESENTATIVE <br />Deaver, CO 80203 l~ L - IZ <br />ACORD 26l2001R]AI Cnll eT3d2R56 Tole3R9R97 CafEe5979d36 ®ACORD CORPORATION 1988 <br />
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