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GENERAL51704
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GENERAL51704
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Entry Properties
Last modified
8/24/2016 8:37:51 PM
Creation date
11/23/2007 7:01:03 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1984063
IBM Index Class Name
General Documents
Doc Date
9/22/2003
Doc Name
Certificate of Insurance
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD CERTIFICATE OF LIABILITY INSURANCID B DATE (MMIDD/VY) <br />PI 09/16/03 . <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION - - - <br />EnRisk Services, Inc. RECEIV OLDER. THSCERTIFICATE DOES NOT AMENDREXTEND OR <br />6100 Western Place, Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. - <br />Fort Worth_TX 76107 ~ ' <br />Phone:~817=877=1884 SEP 72 Z O3 INSURERS AFFORDINGCOVERAGE <br />INSURED _ ~ ~ INSURER A: $t. Pdul Surplus Lines Zns. <br />^ Abraxas Petroleum Corporatponl0n of Minerals ~ SURER B <br />Ms. Car01 Ol Brlen INSURER C: <br />P.O. BOX 701007 INSURER D: <br />San Antonio TX 78270-1007 <br />i INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH 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 LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LiR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATEYMM/DDIYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 , OOO , OOO <br />A X COMMERCIAL GENERAL LIADILITV MU05533725 09/01/03 O9/O1/O4 FIRE DAMAGE (Any one fre) $ 100,000 <br /> CLAIMS MADE OCCUR MED EXP (Any one person) $ $,OOO <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMRAPPLIES PER: PRODUCTS-COMP/OP AGG 3 1,000,000 <br /> X POLICY jEa LOG <br /> AUT OMOBILE LIABILITY <br />COMBINED SINGLE LIMB <br />§ <br /> ANY AUTO (Ea actitlen[) <br /> ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />~ <br />(PBf PeRO^) § <br /> HIRED AUTOS - <br />BODILVINJURY' ~ <br /> <br />NON-OWNED AUTOS - <br />(Peraaitlenp § <br />.- -.-,_ <br /> - PROPERTY DAMAGE-~ - $ <br /> (Per eccidenl) - <br /> GARAGE LIABILITY AUTD ONLY-EA ACCIDENT $ ~ - <br /> IANVAUTO EA ACC g - <br /> OTHER THAN <br /> AUTOONLV: qGG § <br /> EXCESS LIABILITY EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE AGGREGATE § <br /> S <br /> DEDUCTIBLE g <br /> RETEMION § g <br /> 'WORKERS COMPENSATION AND- - <br />' - -- -- •---- -~--~ ------ - TORY LIMITS ER -~~ <br /> EMPLOYERS <br />LIABILITY <br />E L EACH ACCIDENT <br />$ <br /> EL DISEASE-EA EMPLOYE § <br /> E.L. DISEASE ~ POLICY LIMB $ <br /> OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED DY ENDORSEMENTISPECIAL P0.0VISION3 <br />Certificate Holder included as Additional Insured and Waiver o£ Subrogation <br />provided as required by written contract but only to the extent of such <br />contract and only £or operations performed by or £or the Named Insured. It <br />is warranted that no coal mining oeprations are being conducted by the <br />Insured. <br />- n n~cl mn: a ~.wn~.uwnvrv <br />DIVISIO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSWNG INSURER WILL ENDEAVOfl TO MAIL .,3~OAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL <br />D1V1al On o£ Minerals 6 Geology IMPOSE NO OBLIGATION OR LIABIDTY OF ANY KIND UPON THEINSURER, ITS AGENTS OR <br />Attn: Mr. Byron Walker <br />1313 Sherman STreet REPRESENTATVES. <br />Denver CD 80203 AUTHORIZED REPRESENTATI wA _~' <br />
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