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ACORD CERTIFICATE OF LIABILITY INSURANCE CSR TK DATE (MMIDD/YVYY) <br />BOWIB-1 OS 19 04 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Putnam Agency, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P . O. Box 991 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Ashland KY 41105 <br />Phone: 606-329-2200 Fax: 606-325-7787 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED Rrl ~~~~~'~ IR,ISURER A: Federal Ina• CO. <br />INSURER B: American Empire Ina• - <br />Bowie Resoyources, LLC INSURER C: Pinnacol Assurance <br />POf8oxu5057 MAY 2 9 2004 INSURER D: Llo d's Of London <br />Ashland RY 41105-5057 <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE kISURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W HICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAV PERTAIN, THE INSURANCB AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMBS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER PATE MMN)D I DATE MMR) LR,9T5 <br /> GENERAL LLABILRV EACH OCCURRENCE f 1 U D O D D D <br />A X COMMERCIAL GENERAL LIABILITY 37111143CHI D2/UijD4 D2jD1jo5 PREMISES Eaocglrmce) f 1D0DDDO <br /> CLAIMS MADE OCCUR MED £XP (Any me persm) f 10000 <br /> PERSONALBADV INJURY SIDDDDDD <br /> GENERAL AGGREGATE f 2DDU0DO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTB-GDMPX)P AGG 51000000 <br /> POLICY JECT LOC $m Bea. 1DDDDDD <br /> AU (OMOBILE LIABILRY <br />COMBINED SINGLE LIMIT <br />SIDDDDUD <br />A X ANY AUTO 73525270 01/31/04 01/31/05 (Ea actidmi) <br /> ALL OW NED AUTOS BODILY I WURY <br /> SCHEDULED AUTOS (Pe' PBf50") <br /> HIRED AUTOS <br />BODILY INJURY <br />S <br /> NON-0WNED AUTOS (Per acddmp <br /> PROPERTY DAMAGE <br /> <br />(Per acadmp S <br /> GA RAGE LUUIILrfV AUTO ONLY-EA ACCIDENT f <br /> ANY AUTO OTHER THAN EA ACC S <br /> AUTO ONLY: AGG S <br /> IXCESSNMBRELLA LUlBILRY EACH OCCURRENCE f SODDDOD <br />B X OCCUR CLAIMS MADE 4C[T11917 D2jDijD4 D2jD1jD5 AGGREGATE S <br /> f <br /> DEDUCTIBLE S <br /> X RETENTION f tiOn f <br /> WORKERS COMPENSATK)N AND TORY LIMITS ER <br />C EMPLOYERS'LIABILDY <br />ANY PROPRIETOR/PARTNER/EXECUTNE 4077356 D2jU1jD4 D2jDl/D5 E.L. EACH ACCIDENT SIDUDDDD <br /> OFFICER/MEMBER EXCLUDED'! E.L. DISEASE-EA EMPLOYE S iDDOD00 <br /> If s, desMbe antler <br />SPECIAL PROVISIONS below <br />E.L. DISEASE POLICY LIMB <br />S 10 D D O D D <br /> OTHER <br />D BLlaipment Floater B105804RSOM0954 02/09/04 O1j01j05 $1000 Dad $100,000 <br /> Rested/Leas <br />DESCRIPTION OF OPERATIONS (LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Bowie No. 2 Mine (Permit #C-1996-083) - Township 13 South, Ranga 91 Weatr <br />6th P. M. I hereby certify that this Is a true and <br />correct copy of the original <br />This the ~'da of 206_.___ <br />ota .fublic <br />STAT813 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEd1 BEFORE THE EXPIRATKN <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 D DAYS WRRTEN <br />State of Colorado NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Division Of Minerals & GElOlOgy IMPOSE NOOBLIGATION OR LIABILfTY OF ANY KIND UPON THE INSURER,R$AGENTS OR <br />1313 Sharman Street, RM 215 <br />Denver CO 80203 REPRESENTATIVES. <br />