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<br />CERTIFICATE OF INSURANCE <br />issued by the <br />STATE COMPENSATION INSURANCE AUTHORITY <br />950 BROADWAY, DENVER, COLORADO 80203, (303) 837-4000 <br />TO WHOM IT MAY CONCERN: <br /> <br />FAIhl~t7 Wh:D <br />IVIC~'~' <br />This is to certify that this company has issued a Standard Workmen's Compensation and Employer's <br />Liability Policy as described below covering the liability imposed upon subject employers by the <br />Workmen's Compensation Act of Colorado, saki policy being in good standing as of this date. <br />POLICY NUMBER: 195122-0 APRIL 20, 1990 <br />POLICY PERIOD: JULY 1, 1989 TO JULY 1, 1990 <br />INSURED: RICHARD E. CURRY DBA <br />CURRY CONSTRUCTIGN <br />P.O. BOX 236 <br />KREMMLING, CO 80959 <br />DATE OF ORIGINAL ISSUE: APRIL 30, 1987 <br />INDIVIDUAL IS NOT COVERED QUARTERLY P.DJUSTMENT <br />ISSUED TO: COLORADO MINE RECLAMATION DIVISION <br />1313 SHERMAN #21~ <br />DENVER, CO 80203 <br />ATTN: TOM GILES <br />** FOR ADDITIONAL COPIES, THIS CERTIFICATE MAY BE REPRODUCED. ** <br />IDIPORTANT: THE COVERAGE DESCRIBED ABOVE IS IN EFFECT AS OF THE ISSUE DATE <br />OF THIS CERTIFICATE. IT IS SUBJECT TO CHANGE AT ANY TIME IN TEE FUTURE. <br />All policies are subject to the following plwision of t' ~ Workmen's Compensation Act with respect to cancellation: <br />Section B-54-~ 14. If any employer shall be in arrea~ ~ for more than Yhirty days in any payment required to be mzde <br />by him to the State Compensation Insurance Authority as provided by this Act, he shall by virtue of such <br />arrangement be in detautl of such payment and any policy issued to him by said Authority shall thereupon be <br />cancelled without notice as of the effective date or renewal date of ,'aid policy. <br />STATE COMPENSATION INSURANCE AUTHORITY <br />FORM P-267 (6-88) <br />GE:jj <br />~ GERALD BOYSEN< ,'IISURANCE P.EPPWSENTATI~B <br />