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GENERAL53478
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GENERAL53478
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Entry Properties
Last modified
8/24/2016 8:39:00 PM
Creation date
11/23/2007 8:39:13 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981018
IBM Index Class Name
General Documents
Doc Date
4/1/2005
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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ACORD CERTIFICATE OF LIABILITY INSURANCE CSR DN DATE (MM/DD/YYYY) <br />DESER-3 03 28 O5 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Hays Companies HOLDER. THIS CERTIFICATE DOES NO7 AMEND, EXTEND OR <br />80 South 8th Street #700 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Minneapolis MN 55402 <br />Phone: 612-333-3323 Fax: 612-373-7270 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Federal Insurance Com an 20281 <br /> INSURER B: <br />Deseret Generation & Transmiss <br />Attn: Soren Sorensen INSURER C: <br />10714 South Jordan Gateway INSURER D: <br />South Jordan UT 84095 <br /> <br /> INSURER E' <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMTHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 70 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER PATE' MMIDDmE GATE MMIDDm LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1 ,ODD , DD O <br />A X COMMERCIAL GENERAL LIABILITY 73194464 12/30/04 12/30/05 PREMISES (Eaocwrence) 8100,000 <br /> CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 1 O , OOO <br /> X EBL $1,000,000 PERSONALSADVINJURV $ 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 PRO LOC <br />JECT <br /> AU TOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br /> <br />ANV AUTO <br />(Ea accident) $ <br /> ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br />(Per person) $ <br /> HIRED AUTOS <br />BODILY INJURY <br />$ <br /> NON-OWNED AUTOS IPer aaident) <br /> PROPERTY DAMAGE <br /> <br />- <br />(Per accidenU $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 8 <br /> ANY AUTO OTHER THAN EA ACC $ <br /> • AUTO ONLY: AGG $ <br /> E%CESSNMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR ^ CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br />---" -- - <br />CC}BEN <br />EE <br />EAGH <br />3 ~ --- <br /> ANV PROPRIETORIPARTNER%EXECUTIVE --" . <br />~A <br /> OFFICER/MEMBEREXCLUOED? EL. DISEASE-EA EMPLOYEE $ <br /> If yes, describe untler <br /> SPECIAL PROVISIONS belay E.L. DISEASE-POLIGV LIMIT $ <br /> OTHER <br /> i <br />7 ~~ <br />DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Re: Deserado Mine in Rangely <br />Colorado (Permit #C-61-018). <br />, <br />~ 1205 <br />~,i Z L <br />Division of Minerals any Gc~~.• <br />CERTIFICATE HOLDER CANCELLATION <br />State of Colorado <br />Division of Minerals S Geology <br />1313 Sherman Street Room 215 <br />Denver CO 80203 <br />COLSTAI SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />GATE THEREOF, THEI$SUING INSURER WILLB7WLMAIL 3O DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT O~OENp00~L$HALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />ecnan 9R nnm /nRL <br />
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