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GENERAL52880
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Entry Properties
Last modified
8/24/2016 8:38:36 PM
Creation date
11/23/2007 8:07:20 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1984062
IBM Index Class Name
General Documents
Doc Date
3/23/1992
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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III IIIIIIIIIIIIIIII <br />~ AI:II~.u. <br />~OF. <br />~,~CERTIFIC <br />INSURANCE ~ISm) 999 °'"Y' <br />I <br />, <br />. <br />._ _ <br />:5:'L$:.i1-i1FiY~~~,t o_ ,~...... 9 4/ 1 9/ 9 2 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br /> CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE <br />S E D G W I C K J A M E S O F T N <br />I N C DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TH E <br />, <br />. POLICIE5BELOW. <br />P. 0. BOX 19810 <br />KNDXVILIE,TN 37939 COMPANIES AFFORDING COVERAGE <br />615 564-9101 <br />( ) -~ - -- -- - -- ~ ~ __._.._ ... ._. .. <br />A: OLD REPUBLIC INSURANCE CO, <br /> COMPANYA <br /> LETTER <br /> B <br />_ ___________._-_-._.--__-._..______..__... COMPANY B <br />INBURED LETTER <br />CYPRUS MINERALS CO. <br />, <br />( <br />~~-- ~ ~ <br />~ C: ~ ~ <br /> COMPANY <br />l <br />L <br />C <br />~~, <br />AND ITS SUBSIDIARY CO. LETTER <br />~/ <br />d ~'~ <br />P , 0 . BOX 3 2 9 9 - ~~-~ ....... .... ..D <br /> - <br />COMPANY D <br /> <br />ENGLEWOOO,CO 80155 •,~ q <br />LETTER _v1AR [,- . <br />--- --- <br />-- ----- - -- 3 199i -- <br /> E <br />COMPANY E <br /> 'A <br />LETTER IVI(n <br /> <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANC E AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />COi I <br />POLICY NUMBED <br />LTR TYPE OF INSURANCE .POLICY EFFECTIVE POLICY E%PIRATION <br />LIMIT9 <br />i DATE (MM/OD/YYI DATE (MM/DD/YY) <br />GENERAL LIABILITY ~ GENERAL AGGREGATE f A <br />I COMMERCIAL GENERAL LIABILITY ~ PROOUCTS~COMP/OP AGG. f ~ <br />CLAIMS MADE OCCUR ~ PERSONAL 8 ADV. INJURY f 9 I <br />OWNER'S 6 CONTRACTOWS PROT. ~ / / / / EACH OCCURRENCE f 9 <br />I <br />~ _ <br />FIRE DAMAGE (Any pna Ilrs) t <br />0 <br /> -- <br />MED. EXPENSE (My aro paean) f 0 <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE <br />ANY AUTO LIMIT t 0 <br />~ ~ ALL OWNED AUTOS <br />I ~ BODILY INJURY <br />f <br />~ SCHEDULED AUTOS ! / / / / (Par parapn) 0 <br /> <br />' HIRED AUTOS <br /> <br />' ~. NON~OWNED AUTOS ~ - - <br /> <br />BODILY INJURY S <br />(Per axcleanq ' <br /> <br /> <br />(~ <br />' j GARAGE LIABILITY <br />Ir1l PROPERTY DAMAGE S 9 <br />I <br />j EXCESS LIABILITY ! EACH OCCURRENCE f 0 <br />~~ UMBRELLA FORM / / / / AGGREGATE f 0 <br />^I OTHER THAN UMBRELLA FORM I ' <br />WORKER'8 COMPENBATION I STATUTORY LIMITS <br />~ EACH ACCIDENT 3 1. 0 0 9. 6 6 0 <br />A' ANO 0000404604 <br />~ ~07 01 91 07 01 92~~~~~ ~ _ 1,000,00 <br />/ / / / DISEASE-POLICY LIMIT S 0 <br />' EMPIOYERB'LIABILITY - -' - - -- <br />DISEASE-EACH EMPLOYEE 5 1, 0 0 0, 0 0 <br />0 <br />OTHER <br />AIEXf,ESS W.C. (1) EX266 07/01/91 07/01/92 STATUTORY <br />DEBCRIPTION OF OPERATIONS/LOCATIONS/VENICLE9/BPECIAL ITEMB i <br />/t 1 FYnFCC 1.1 n GDDI TFC Tf1 rn VV On LIT nl n9 r_n rn r,IT Iwn uu ii <br />VT, NV,WV TWE NTYMI LE COAL CO. F,OIOEL CRE~ED~MINE PERMIT'#~C'-82-058, <br />YAMPA COAL CO., MINE #3 PERMIT~'A;G-="84=0`62,°MINES 1S2 & ECKMAN PARK <br />COLORADO <br />#C-81-071 + <br />~ CERTIFICATE HOLDER~~'t~r.,. y~;,L-; '-',: ,,_,- , _ _,- ,.CANCELGiTiON _ <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE <br />EXPIR I N DATE THEREOF, THE ISSUING COMPANY WILL }~9 <br />STATF qF ('01.ORADO I ~ I <br />M I N F. I_ q AI D R E C L A M A T I O N DEPT MAIL _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE I <br />1 3 1 3 S H E R M A M STREET , SUITE 2 1 S ~ LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR <br />LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. <br />' AUTHORIZED REPRESENTATIVE <br />i ~~ _ <br />! ACORD 25•S (7/90) 1 L'7 'y"'~ ~~~-' v ~ ~ ..®ACORD CORPO'HATION'1990~ <br />
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