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GENERAL51903
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GENERAL51903
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Entry Properties
Last modified
8/24/2016 8:37:59 PM
Creation date
11/23/2007 7:13:40 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981035
IBM Index Class Name
General Documents
Doc Date
3/24/2005
Doc Name
Certificate of Insurance
From
Accord
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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DATE(MM/DD/vv> ; <br />' <br />03/16/05 <br />' ACORD,M CERTIFICATE OF LIABILITY INSURANCE . <br /> .. <br />PRODUCER <br />Aon Risk services inc. of Pennsylvania THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />DOmi ni on Tower, loth F10or AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />625 Li betty Avenue CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />Pittsburgh PA 15222-3110 USA COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> INSURERS AFFORDING COVERAGE <br />PxoNE. 866 283-7124 Fax- 866 4 <br />wsuReD wsuRERA: National union Fire xns co of Pittsburgh <br />National King coal, LLC <br /> <br />4424 County Road 120 MAR SURER B: <br />2 4 200 <br />Hesperus Co 81326-9545 u5A wsuRER C, <br />Division of Minerals 8 G suRER o <br /> wSURER E'. <br />:-COVERAGES This Certificate is ndtiritended tos cl alleriddrsements"covera es?[enns conditions add ezclusidnS"of the bliciesshown. '- "'~~"~~'~°'` <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE MSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDMG <br />ANY REQUIREMENT, TERM OR COND1710N OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIB ED HEREIN IS SUBJECT TO ALL THE TEAMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF wSURANCE <br />POLICY NUMBER POLICY EFFECTIVE <br />DATE(MM\DD\YV) POLICY EXPIRATION <br />DATE(MM\DD\YY) <br />LIMITS <br />A GENERAL LIABILITY GL5442702 12/13/04 12/13/05 EACH OCCHRRENCE E2, 000, 000 <br /> X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anv one fire? $1,000,000 <br /> CLAIMS MADE X^ OCCUR LSD EXP (Am one person) SS , 000 <br /> PERSONAL&ADV w1URY $2, ODD, OOO <br /> GENERAL AGGREGATE $4,000,000 <br /> <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OP AGG <br />$4,000,000 <br /> PRO- <br />X <br />~ <br />~ <br /> POLICY <br />LOC <br />IECT <br /> A UTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO <br />(Ps accident) <br /> ALL O WNED AUTOS BODILY wNRY <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS- BODILY wNRY <br /> (Pa accidenO <br /> NON OWNED AUTOS <br /> PROPERTY DAMAGE <br /> (PCr accident) <br /> <br /> GARAGE LIABILITY AUTO ONLY. EA ACCIDENT <br /> ANY AUTO OTHER THAN EA ACC <br /> AUTO ONLY: <br /> AGG <br /> EXCESS LIABILITY EACH OCCURRENCE <br /> OCCUR ~ CLAIMS MADE AGGREGATE <br /> <br /> DEDUCTIBLE <br /> RETENTION - ~- - - - --~ <br /> WORKERS COMPENSATION AND <br />' WC STATU- OTH- <br />TORY LIMITS ER <br /> EMPLOYERS <br />LIABILITY E.L. EACN ACCIDENT <br /> E L. DISEASE-POLICY LIMIT <br /> E L. DISEASE-EA EMPLOYEE <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />Re: 05M Permit co-OlOla.; CDMB Permit C-81-035 <br />Certificate Holder is added as an Additional ln su red as required by written contract but limited to the operations <br />of the insured under said contract, and always subject to the policy terms, conditions and exclusions. <br />CERTIFI ATEHOLDER ' `"""" ~~=:- ' ~- °'='; "° ~ ~ `-,EANCELLATION ~ ~~' ' ~ `~ ~~ ~ ~ "" "" <br />DI VI Sion Of Mi nerdl5 and Geology SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />1313 Sherman street, ROOM 21S DATE THEREOF, THE ISSUMG COMPANY WILL ENBbAVOR-TO MAfL <br />Denver CO 80203 USA <br />I 30 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br /> AUTHORIZED REPRESENTATIVE ~ ~ /~ <br /> <br />C <br />W <br />.~ <br />z <br />L <br />S <br />C <br />s <br />_~ <br />4~_.[~. <br />Y_2 <br />f. <br />~_ <br />~_ <br />~~ <br />
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