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GENERAL53257
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GENERAL53257
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Entry Properties
Last modified
8/24/2016 8:38:52 PM
Creation date
11/23/2007 8:27:49 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981021
IBM Index Class Name
General Documents
Doc Date
4/23/1981
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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-_ _ _ - _ Ci= 1"r/Y, CRvTolli Inir Lv7Ye~~?F <br />V J <br />CC~~~L~I~LS~ III'llllllll Lill 111 . . <br />yl ~I ~ <br />~~ <br />~~~ <br />~ <br />V <br />£ <br />qT I (~'' . w -•• ~ . `t ~. £ /.`~.r~ 999 r ~:;n,., <br />K .~F : f~.'LN > 7~/ty~°'R-0 I'~yi L I~[J i 1[M TiT. ~,tl.lal. .e i a -:' _ L , F „ <br />j '"r1,lF i ~7J}~ <br />`~lli(r~e 06' <br />~ <br />. <br />. <br />j? <br />r~i-.i9:1` ee+ - ,-E E Z,~IS <br />I jl~' <br />'F~13 <br />~~J?° <br />- <br />3 <br />° <br />'l '' ~'~' <br />- <br />.. <br />~ <br />4t <br />. ~ <br />g°?. <br />NAME AND ADDRESS OF AGENCY <br /> COMPANIES AFFORDING CObERAGES <br />Beeson-Taggart b Associates, Inc. <br />P. 0. Box 147 COMPANY <br />LETT <br />R <br />Boulder, Colo. 80306 E <br /> COMPANY P~ <br /> LETTER <br />NAME AND ADDRESS OF INSURED <br />COMPANY <br />Walden Coal Company LETTER <br /> <br />P, 0. Box 229 COMPANY D n 4 ~(j07 <br />LETTER G <br />JC71 <br />Boulder <br />Colo <br />80306 / <br />, <br />. <br /> COMPANY <br />LETTER )YtINED LAND RECLAMATION~•COAL <br /> COLO. DEPT. OF NATUftN. R <br />This is to certify that policies of insurance listed below have bee n issued to the insured named above and are in force at this time. <br /> Limits of Llabili in Thousands <br />COMPANY <br />LETTER TYPE OF INSVRANCE POLICY NUMBER POLICY <br />EEPIRAiION DATE EACH AGGREGATE <br /> OCCURRENCE <br /> GENERAL LIABILITY <br /> BODILY INJURY f 300 f 300 <br /> <br />A <br />®COMPREHENSIVE FORM <br />AGC 456 167 <br />5/1/81 to , , <br /> ®PREMISLG-OPERATIONS 5/1 /p.1 <br />OO PROPERTY DAMAGE f 'z5o f 2)rD <br /> ^ ExPLO510N AND COLLAPSE <br /> n HAZARD <br /> L)(1 UNDERGROUND HAZARD <br /> PRODUCTS/COMPLETED <br /> OPERATIONS HAZARD <br />® CONTRACTUAL INSURANCE BODILY INJURY AND <br /> <br />BROAD FORM PROPERTY PROPERTY DAMAGE <br />COMBINED f f <br /> DAMAGE <br />® INDEPENDENT CONTRACTORS <br /> ® PERSONAL INJURY PEPfONAL IN JURY f <br /> AUTOMOBILE LIABILITY BoDILV INJURv <br />f 250 <br />A ©COMPREHENSIVE FORM AGC 456 167 p <br />5~1~81 t0 BODILY ENJURY f SDD, .1. <br /> <br />© OWNED 5/1/82 (EACH ACCIDENT) <br />°t`- <br /> I~I <br />I <br />L)(1 HIRED PROPERTY DAMAGE S L <br />1' <br /> ` <br />' <br /> L)(I NON-0WNED BODILY INJURY AND f <br />j , . ,~ <br />~~~ <br />' <br />~ <br /> PROPERTY DAMAGE ~ <br />y,, <br />gg.. <br /> COMBINED -':t `~~ <br /> EXCESS LIABILITY <br /> <br />~ UMBRE <br />A FOR p <br />8 BODILY INJURY AND <br />A LL <br />M UM6 279 206 1 t0 <br />SI1~ PROPERTY DAMAGE fIO,000 f1O,000 <br /> ^ OTHER THAN UMBRELLA r)~1I82 COMBINED <br /> TORN <br /> WORKERS' C00.7PENSATION STATUTORY yy- f.'y.~ >f:{~i~"- "'" <br /> and ter..-~.:.,'~`±.:>rr. <br /> EMPLOYERS' LIABILITY a `'"' ' f <br />1[ILN ACUD[Nil <br /> OTHER <br /> <br />DESCRIPTION OF OPERATIOHSA-OCATIONSNEHICLES <br />Surface mining and reclamation operati on at Bourg coal property <br />Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com- <br />pany will endeavor to mail 1.0__ days wri tten notice to the below named certificate holder, but failure to <br />mail such notice shall Impose no obligation o r liability of any kind upon the company. <br /> <br />NAME ANp ADDRESS OF CERTIFICATE HOLDER. O <br />4 22 81 <br /> DATE ISSUED <br />Mined Lahd Reclamation Board <br />1313 Sherman Street ~ <br />Denver, Colo. 80203 _ <br />( <br />j7` <br /> ~ <br />AUTHORIZED REPR ATIVE <br />ACORD 25 (Ed 11 ))1 <br />
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