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GENERAL52935
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Entry Properties
Last modified
8/24/2016 8:38:39 PM
Creation date
11/23/2007 8:09:10 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981014
IBM Index Class Name
General Documents
Doc Date
1/19/2005
Doc Name
Certificate of Insurance
From
Brown & Brown Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD CERTIFICATE OF LIABILITY INSURANCE ENERG 15 DA OS N14/O5 <br />PRODUCER <br />Brown fi Brown Insurance <br />Steamboat Spgs POS 775043 <br />2150 Resort Drive, #250 THIS CERTIFICATEIS ISSUED AS AMATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHfS UPON THE CERTIFICATE <br />HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Steamboat Springs CO 80477-5043 <br />Phone: 970-879-1363 Fax:970-879-0239 <br />INSURERSAFFORDNGCOVERAGE <br />NAIC# <br />INSURED INSURERA CHUBB fi SON ZNC <br /> INSURER B: <br />Energy FLTels Corporation INSURER C: - <br />PO BOR 773457 <br />CO 80477-3457 <br />St <br />b <br />t S <br />i INSURER O: <br />pr <br />eam <br />oa <br />ngs INSURER E: <br />COVERAGE <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED i0 THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDICATED. NOTWITHSTANDING <br />ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR N$R TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MMIDD/YY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br />A I X COMMERCLILGENERALLIABILITV 79544662 10/01/04 10/Ol/OS PREMISES (Eaoccurence) E50,000 <br /> CLAIMS MADE ~ OCCUR MEO EXP (Any one person) $ lO , OOO <br /> PERSONAL SAOV INJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 <br /> POLICY PRD <br />JECT LOC Ben. 1,000,000 <br /> AUT OMOBILE LIABLLITY <br />COMBINED SINGLE LIMIT <br />$ <br /> ANV AUTO (Ea accitlem) <br /> ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br /> SCHEDULED AU70S (Per person) <br /> HIRED AUTOS <br />BODILY INJURY <br />$ <br /> NON-OWNED AUTOS (Per acoitlenl) <br /> PROPERTY DAMAGE <br /> <br />(Per a¢itlenl) $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 8 <br /> ANV AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLALLABILITY EACH OCCURRENCE $ <br /> <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? <br />E. L. DISEASE-EA EMPLOYEE <br />$ <br /> It yes, tlescribe under <br /> SPECIAL PROVISIONS belay E. L. DISEASE-POLICY LIMIT $ <br /> OTHER <br />DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BV ENDORSEMENT I SPECIAL PROVISIONS <br />Raton Creek Mine - Permit #C-82-055 <br />Kerr Mine -- Permit #C-80-006 <br />Southfield Mine - Permit #C-81-014 <br />CERTIFICATE HOLDER CANCELLATION <br />Colorado Department <br />Natural Resources <br />Division of Minerals <br />1313 Sherman Street, <br />Denver CO 80203 <br />CN11rruRA. SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRATIOI <br />Of DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O OAV$ WRRTEN <br />NOTICE TO THE CERTIFIC lE OLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL <br />fi GE!OlOgy IMPOSE NO <br />Rm 215 <br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />©ACORD CORPORATION 1 <br />
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