GENERAL52591

• Permit No: C1981010
• IBM Index Class Name: General Documents
• Doc Name: CERTIFICATE OF INSURANCE
• Permit Index Doc Type: INSURANCE
• Media Type: D
• Archive: No

tSidqurick:~.Jemes of TNi Inc.
- .=kenphis.,.'Tn 38119
BLSURED..._ _- :___... ..
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ililliams.Fork ComFany
P. 0. Box 187
-~CPaig.,:,;,::-•.'. ;...,. CO ..81626
~~ IS CERTIFY II I IIIIIIIIIIIII III DFORMATION(ONI/Y~~D ,~'
CONFERS NO RICH. 999 'E MOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
-,.. COMPANIES AFFORDING COVERAGE
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' COMPANY
LETTER
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LETTER
COMPANY
LETTER
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LETTER D ~ ,-. (PINK
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, .. THIB IS TO CERTIFY THA7 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
I .. WDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUTAE NT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
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. 'EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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_a[y.; ~ jYPE OF IN6DMNCE ..---. POLICY EFFECTIVE POLICY EXPIgATION
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LIMITS
POLICY NUMBER ' ~
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DATE (MMIDDIVYI I DATE (MMIDDIYY) I
-. ~ A GEN ERAL LIABILITY 4
371 00018 _ _ . _ -.
GENERAL AGGREGATE ~3 j
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MED. EXPENSE IAny pertwQ 3 n n 1
AUT OMOBILE LIABILITY ~ ~ ~ I COIAB WED SI;:GLE~ I S
• ANY AUTO / i I LIMIT
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ALL OWNED AUTOS JURV
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(UMGE LIABILITY ~ ~ I
- I i PROPERTY DAMAGE i 3
'^ EICE33 LdBIL1TY ~ I I EACH OCCURRENCE 3
"' "~' UMBPELUI FORM ~"' ~~ ~ j r AGGREGATE 3
OTHER THAN UMBRELLA FORM '11 ~ ~ ' • I-- ~'
";: _ ;-<. ~' WORXER,'9 COMPENSATION ~ L / ~'~ STAi UTORY LIMITS s T_ y
(L~ ~`. 'a :.-y~i'ryilfny. ~: AND .'. .... - :: , ''' lt:l~ J ACCIDENT .i ~..^:
' ~ -':-~ ^•"' "' ~' .i;,w,.. ~1 YI DISEASE-POLICY LIMIT 3
- ~ ' I-~t. EMPLOYERS' LIABILITY ~ ~ Y ~ I--" '
'~`f ~~.+.;; - ,'I~ ~ DISEASE-EACH EMPLOYEE i
I ~I . ' OTNER -. _. - . - . .
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Golorado~Mine.:Land Raclamstion
Y~tision„Attn:-.:.Tony Naldron.
l,~13.,Sherman.,5treet -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ~~• DAYS WRITTEN N IC O THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAILS H NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON HE MPANY, ITS AGENTS OR REPRESENTATIVES.
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