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GENERAL53369
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GENERAL53369
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Last modified
8/24/2016 8:38:56 PM
Creation date
11/23/2007 8:33:08 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1983059
IBM Index Class Name
General Documents
Doc Date
1/9/2006
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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Attachment to AC012D Certificate for oxbow carbon a Mi neral s LLc <br />The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the <br />coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in [he <br />policy. <br />wsuaeo <br />oxbow carbon & Minerals uc <br />1601 Forum al <br />attn: Donna 7. Gulbransen <br />west calm Beach FL 33401-8101 usa <br />ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD <br />certificate form for policy limits. <br />POLICY POLICY <br />INSR TYPE OF INSURANCE POLICY NUMBER EFFECTI\'E E%PIRATION LIMITS <br />LTR POLICY DESCRIPTION DATE DATE <br />DESCRHPTION OF OPERATIONS/LOCATIONS~VEFnCLESIEXCLUSIONS ADDED HY <br />ite: Terror creek company. C-1983-059 <br />_.. commercial_General_Liabi].i.ty_covers use_of_ezplosives~ _ _ ~_ - _~ _ _ ._ . - _ ~ _ _ <br />Division of Minerals & Geology is named as an additional insured excluding workers' compensation and <br />employers' Liability as required by written contract but limited to the operations of the insured under <br />said contract, and always subject to the policy terms, conditions and exclusions. <br />Certificate No : 570016169167 <br />
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