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GENERAL51319
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GENERAL51319
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Entry Properties
Last modified
8/24/2016 8:37:37 PM
Creation date
11/23/2007 6:41:42 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981032
IBM Index Class Name
General Documents
Doc Date
5/25/1987
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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COMPANIES AFFORDING COVERAGES <br />EXANDER fi ALE%ANDER INC <br />. <br />AL THE TRAVELERS INDEMNITY COMPANY <br />2120 So. 72nd Street COMPANY A <br />Nebraska 68124 <br />ha <br />O LETTER OF RHODE ISLAND <br />ma <br />, <br /> COMPANY B THE TRAVELERS INDEMNITY COMPANY <br />LETTER <br />NAME PND ADDRESS OF INSURED /~ <br />COMPANY ^ <br /> LErrER V <br />l C <br />h <br />C <br />oa <br />ompany <br />Nort <br />ern <br />2223 Dodge Street COMPANY D <br /> LETTER <br />8 <br />Omaha, Nebraska 6 <br />102 <br /> COMPANY C <br />LETTER <br /> <br />This is to certity that policies of insurance listed fxlow have been issued to the insured named above and are in force at this time. Notwithsuntling any rLquirement, term or condition <br />of any contract or other document with respect to which this certificate may f>e issued or may pertain. the Insurance eHOrdetl by the policies dexribed herein is subject to all the <br />terms, a%CIUSions and condltlOns of such policies. <br />PANY <br />~ POLICY Limits of Liability in Thousan S <br />.OM <br />. <br />LETTER TYPE OF INSURANCE POUCV NUMBER E%PIRATION DATE EACH AGGREGATE <br /> OCCURRENCE <br /> GENERAL LIABILITY <br />BODILY INJURY <br />S 250 <br />S 500 <br />A ®COMPREHENSIVE FORM <br /> ® TREE-NSL-133T873-A-81 6-1-82 2 <br />O 500 <br /> PREMISES-OPERATIONS PROPERTY DAMAGE S <br />S S <br /> E%PLOSION AND COLLAPSE <br /> [~ HAZARD <br /> I)LJ UNDERGROUND HAZARD <br /> l~l PRODUCTS/COMPLETED <br /> WI OPERATIONS HAZARD <br />n CONTRACTUAL INSURANCE BODILY INJURY AND <br />PROPERTY DAMAGE <br />S <br />S <br /> ® BROAD FORM PROPERTY COMBINED <br /> DAMAGE <br />^ INDEPENDENT CONTRACTORS <br /> ~J PERSONAL INJURY PERSONAL IN JURY S 500 <br /> AUTOMOBILE LIABILITY eoDILVINJUgv s 25D <br /> <br />A <br />E F <br />~ COMPREHEN <br />I <br />RM TREE-NSL-133T873-A-81* 6-1-82 (EACH PERSON) <br />S 250 <br /> V <br />S <br />O BODILY INJURY <br /> ® (EACH ACCIDENT) <br /> OWNED <br />B ®HIRED TR-CAP-162T813-0-81 PROPERTY DAMAGE S 2SO <br /> BODILY INJURY AND <br /> NON OWNED PROPERTY DAMAGE S <br /> COMBINED <br /> EXCESS LIABILITY <br /> <br />^ UMBRELLP FORM BODILY INJURY AND <br />S <br />S <br /> PROPERLY DAMAGE <br /> ^ OTHER THAN UMBRELLA COMBINED <br /> FORM <br /> WORKERS' COMPENSATION STATUTORY <br />p, and TREE-UB-133T867-3-81 6-1-82 <br /> -EMPLOYERS' LIABILITY _ ~ s 25O <br />rt•c n.ccm[~n <br /> OTHER a <br />~~4._°. ' <br />,. .,_ .. <br />)ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES lil 4\~ I_ a. JO <br />*Applicable in State of Texas <br /> <br /> <br />Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- <br />pany will endeavor to mail a days written notice to the below named certificate holder, but failure to <br />mail such notice shall impose no obligation or liability of any kind upon the company. <br />NAME AND ADDRESS OF CERTIFICATE HOLDER. -18-51 L <br />State of Colorado DATE ISSU <br />Department of idatural Resources <br />Mined Land Reclamation Division <br />1313 Sherman Street <br />AUTHOR12E0 REPRESENTATIVE <br />Denver, Colorado 80202 <br />ACORD 25 (1-)R) <br />
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