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GENERAL54558
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GENERAL54558
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Entry Properties
Last modified
8/24/2016 8:39:47 PM
Creation date
11/23/2007 9:37:43 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981044
IBM Index Class Name
General Documents
Doc Date
8/7/1986
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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<br /> <br />F. r .~ r .~r . .. F <br />NAME ANp ADDRESS OF AGENCY <br /> COMPANIES AFFORDING COVERAGES <br />Broadus Anderson & Associates OLD REPUBLIC INSURANCE COMPANY <br />COMPANY <br />P.O. BOX 19810 IETTER <br />A <br />Knoxville,TN 37939 COMPANY <br />S 8 Q - LETTER <br />NAME AND ADDRESS OF INSURED <br />PANY <br />CYPRUS .MINERALS CO. COM <br />LETTER y <br />EMPIRE ENERGY CORPORATION coMPANr D <br />7200 SOUTH ALTON WAY LETTER <br />ENGLEWOOD,CO 80155 COMPANY C ~~~~~y/~u <br />WC~ <br /> ~ <br />~ <br />LETTER L R77~ 717 <br />This is to certity that Policies o1 insurance listed below have been issued to the insured named above and are in force al this time. Notwithstanding any requirement, term or condition <br />of any contract or other document with respect to which this certihute may ce issued or may Pertain, the insurance afforded by the policies describetl herein is subject to all the <br />terms, exclusions and conditions of such policies. <br />COMPANY P <br />Y Limits of Liabilit in Thousan s 0 0 <br />LETTER TYPE OF INSURANCE POLICY rvUMdER OLIC <br />EXPIRATION DATE EALH AGGREGATE <br /> OCCURRENCE <br /> GENERAL LIABILITY <br />0 <br />0 <br /> eomLV Iruuar s s <br /> COMPREHENSVE FORM <br /> ® PREMISES-OPCRATION$ PROPERTY DAMAGE S D s O <br /> ® ExPLOSION AND COLLAPSE <br /> HAZARD <br />A ~UNDERGROUNDHAZARD ZC457H4 07~O1~B7 <br /> ® PRODUCTS/COMPLETED <br /> OPERATIONS HAZARD BODILY INJURY AND <br />2 0 0 0 <br />2 0 0 0 <br /> CONTRACTUAL INSURANCE PROPERTY DAMAGE f 5 <br /> ® BROAD FORM PROPERTY COMBINED <br /> DAMAGE <br />INDEPENDENT CONTRACTORS <br /> ® PERSONAL INJURY <br />PERSONAL IN <br />JURY f <br /> 0 <br /> AUTOMOBILE LIABILITY BODILY INJURY <br />f <br /> COMPREHENSIVE FORM (EACH PERSON) <br />BODILY INJURY f 2 0 0 0 <br />A QOWNED T811331 07~01~87 (EACH ACCIDENT) <br /> <br />H HIRED PROPERTY DAMAGE E D <br /> N <br />NON OWNED BODILY INJURY PND <br />f <br /> PROPFRTY DAMAGE <br /> COMBINED 0 <br /> E%CESS LIABILITY <br /> <br />MBR <br />F <br />M <br />~ ~ BOD4v INJURY AND <br />s ~ <br />f D <br /> U <br />ELLA <br />OR PROPERTY DAMAGE <br /> ^ OT HERTHAN UMBRELLA COMB~NCD <br /> FORM <br /> WORKERS' COMPENSATION sTAruroar <br /> and <br /> EMPLOYERS'LIABILITY s D „>rc irn ~~~ <br /> OTHER <br /> <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES <br />BROAD FORM VENDORS ENDORSEMENT ATTA CHED. <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 30 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 />N SF'fAATE RE~s~FC~OLO~A~~R <br />O 7 Z S 8 6 <br />Mine Land Reclamation Division <br />1313 Sherman Street DATE ISSUED <br />% <br />~~ <br />~ <br />~~ ~~o ~"~'~ <br />.Denver, Colorado 80203 ~ <br />~ <br /> AUTHORIZED REPRESENTATIVE <br />ACORD 25 (1~]9) <br />
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