GENERAL54482

• Permit No: C1983059
• IBM Index Class Name: General Documents
• Doc Date: 6/25/2007
• Doc Name: Certificate of Liability Insurance
• To: DRMS
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

ACORD,. .CER'I'IEICATE.OFT:IABILT TXINSLiR2~l1~ICE `... _. DAos%ii%oi
exoouceR
Aon Risk Services, InC of Florida THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
222 Lakeview Avenue AND CONFERS NO RIGHTS UPON THE CERTHICATE HOLDER THIS
Suite 510 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
West Palm Beach FL 33401 USA COVERAGE AFFORDED BY THE POLICIES BELOW.
PHONE- $66 283-7122 FAx- 847 953-5390 INSURERS AFFORDING COVERAGE
DvsuRED INSURERA-. Hartford Fire insurance Co.
Oxbow Carbon & Minerals LLC INSURERe. Pacific indemnity co
1601 Forum P1
Attn: Donna 7. Gulbransen INSURER C: We6tChe6ter Fire InsU rdn Ce Co
west Palm Beach FL 33401-8101 USA
INSURER D:
INSURER E'
r~CflVERAGES T}iis CertificaleiSnatmteadediil 'nlt:endDTSemenu'° ~?Amms; coadiliDriS:aaddzrlusiousioft>x'liciesshown. ~...~.;SIR.May ~~AApY
THE POLICIES OF INSURANCE LISTID BELOW HAVE BEEN ISSUID TO 7HE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED ,NOTWITHSTANDING
ANY REQUBOIMEN'i, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUID OR MAY
PERTAIN, 7HE INSURANCE AFFORDID BY 7HE POLICBSS DESCRffiID HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDII70N5 OF SUCH POLICffiS.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN RIDUCID BY PABJ CLAIMS.
WSR
LTR
TYPE OF INSDRANCE
POLICY NUMBER POLICY EFFECT POLICY EXPIRATION
LpyTTS
DATE(MMVIO\W) DATE(MM\DD\W)
R GENERAL LIABB,ITY 35863379
l
i
bili 06/01/07 06/01/08 EACH OCCURRENCE $1,000,000

X
COhA~RCW.GENEAAL LIABILITY Genera
L
a
ty
FIRE DAMAGEfAm one fire)
$1,000,000
CLAIMS MADE X^ OCCUR MED EXP (Anv ane cersonl $10, 000
PERSONAL$ADV MNRY $1,000,000

GENERAL AGGREGATE E2
OOO
000
,
,
GENT. AGGREGATE LN1IT APPLIES PER'.
^ PRO- ^ PRODUCTS-COMP/OP AGG $2,000,000
POLICY IECT LOC
A A UTOmoan.e LUen.rrY 20UENZQ6229 09/01/06 09/01/07 COMBINED SmcLE LNOT
Business Automobile -Texas (Fw aafaem) $1,000,000
X ANY wuTO
ALL OWNED AUTOS BODILY INIIIAY
SCHEDULED AUTOS (Per permn)
HBU:D AUTOS
BODRY RJNRY
NON OWNED AUTOS CPQ acddent)
PROPERTYDAMAGE
P
id
(
er acc
anU
GARAGE LIABILTY AUTO ONLY - EA ACCB]ENT
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY
AGG
C EXCESSLUBILrrr G 1 7
b
ll
i
bili 06/01/07 O1 0 EACx occuRRENCE $10,000,000
_
_ _
~
X Um
re
a L
a
ty - - `- - -, ~~~
OCCUR CLAIMS MADE
^ AGGREGATE $10,000,000

DEDUCTB3LE
X RETENTION $10,000
WORKERS COMPENSATION AND
'
' ~~ WC STATU- OTH-
EMPLOY
ERS
LIABB.FrY

2~
E.L. EACH ACCB)EM
SUN 2 5
~ t\OQ. E.L. DISEASE-POLICY LD.DT
ReclaR'
~ of aSetY E L DISEASE-EA EMPLOYEE
o'reeR M1nIn
it
DESCR~TION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ~
RE: Terror Creek Company. C-1983-059 Commercial General Liability covers use of explosives. Division of
Minerals & Geology is named as an Additional insured as required by written contract but limited to the
operations of the insured under said contract, and always subject to the policy terms, conditions and exclusions. i
LDER :; .: ~ _ .~ it ~ . ':.:_: .. . , , ... ... -..: ~ ~ .: .- ~. ... _.. ;::... ,: i
Dl Vl5l00 of Minerals & Geology SHOULD ANY OF THE ABOVE DESCRD3ED POLICES BE CANCELLED BEFORE THE EXPDUIION
1313 Sherman Street, Room 215 DATE THEREOF, THE ISSUING COMPANY WH.L ENB6AY6R-T9 MAD,
Denver CO 80203 USA 30 DAYS WRTITEN NOTICE IYI THE CERTIFlCATE HOLDER NAMED I'O THE LEFT.
BUT FAD.URE TO DO SO SHALL IMPOSE NOOBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, TTS AGENTS OR REPRESENTATNES.
AUTHORIZED REPRESENTATIVE _ /~ / _ /,. / ' _~ _ 1_
d G .r ~...(/i

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