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GENERAL52418
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GENERAL52418
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Last modified
8/24/2016 8:38:18 PM
Creation date
11/23/2007 7:44:03 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981039
IBM Index Class Name
General Documents
Doc Date
5/3/1985
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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~J 1 .._'~~.\,~~~1'.b IIIIII'lllll"IIIII <br />~~~v rpAvf ~~F~~rCyERTIFICATE OF INSURANCE <br />G~rC~l~~l ; ,, • i~.,:;, i;,:cu~r~,~,riaia oiu~~ta~~ <br />'~~ Date May 1, 1985 <br />G~la• G~h i. a{ idcldl^~ "'r ~ : ~~s <br />This is to certify that the following policies have been issued to: <br />Name b Address of Insured Tha Rnrkracrla fn any b Rv,?^ I^criparaterLof Wisconsin and <br />Ryan Incorporated Central, P.O~Box 206, Janesville, WI 53547 <br />Project permit for f,rac5,~ Crank foal Min'ngy Rn rr Gr]u^tyr Cnlnra~^ - Ryan Job Na §712 <br />WORKER'S COMPENSATION <br />Policy No. WC 1 054 607 Inception Date 4/1!85 Expiration Date 4/1/86 <br />Insuring Company gltuminous Casualty Corporation <br />Coverage: Worker's Compensation - Statutory Employers liability Limit : $ 1~D ~o <br />Locations Covered All States En orsament Attar had ro Pnliry <br />COMPREHENSIVE GENERAL LIABILITY: <br />Policy No. GL 1 231 492 Inception Date 4/1/RS Expiration Date 4/USb <br />Insurance Company Bituminous Casualty~'orporation <br />Limits of Liability: <br />Bodily Injury Liability $ Each Occurrence Combined <br />$ Aggregate OR Single <br />Property Damage Liability $ Each Occurrence Limit $ <br />~ <br />nnn <br />$ Aggregate . <br />, <br />Coverage Provided (Check Applicable Blank Yes No <br />Premises Operations _~ <br />Elevators, If Any x <br />Completed Operations/Products x <br />Blanket Contractual Liability to include coverage for "Hold Harmles s <br />Agreement" if such agreement is contained in the specifications <br />of subcontract, subject to policy terms x <br />Personal Injury, Employee Exclusion Deleted x <br />Independent Contractors ~ <br />Employees as Named Insureds _ <br />x <br />Broad form Property Damage, Including Completed Operations _~ <br />Property Damage Liability covers: <br />Damage due to blasting x <br />Damage due to collapse ~ <br />Damage to underground facilities _ <br />~ <br />Broad Form Liability Endorsement _ <br />~_ <br />COMPREHENSIVE AUTOMOBILE LIABILITY: <br />Policy No. BA 1 360 790 Inception Date 4/1/g5 Expiration Date 4/1/86 <br />Insurance Company Bituminous Casualty Corporation <br />Limit of Liability: <br />Bodily Injury Liability $ Each Person Combined <br />$ Each Occurrence OR Single <br />Property Damage Liability $ ~ch Occurrence Limit$ 500.000 <br />Yes No <br />Coverage is provided for operation of all - Owned Vehicles x <br />Non-Owned Vehicles x <br />Hired Vehicles y <br />I <br />
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