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. ~.. <br />UMBRELLA LIABILITY: <br />Policy No. Inception <br />Insuring Company <br />Single Limit Liability: $ <br />Dale <br />ntion: <br />OWNER'S PROTECTIVE OR RAILROAD PROTECTIVE LIABILITY: <br />Policy No. Inception Da [e Expiration Date <br />Insuring Company <br />Name b Address of Insured <br />Limits of liability: <br />Bodily Injury Liability $ Each Occurrence Combined <br />Property Damage Liability $ - - Each Occurrence -OR -Single <br />$ Aggregate Limit <br />SPECIAL COVERAGE: <br />Policy No. Inception Date Expiration Date <br />Insuring Company <br />Name b Address of Insured <br />Amount Deductible <br />MORTGAGE CLAUSE: <br />Loss, if any, [o be adjusted only with the insured named herein and payable to the insured E <br />as their respective interests may appear, subject, nevertheless, to all the terms and conditions <br />of the policy and the Standard Mortgage Clause, U. S. Form No. 127 B (9-34) <br />CANCELLATION: Should any of the above described policies be canceled before [he expiration <br />date thereof, the issuing company will mail~~days written notice to the below named <br />certificate holder, but failure to mail such notice shall impose no obligation or liability <br />of any kind upon the company. Colorado Department of Natural Resources <br />Mined Land Reclamation Division <br />1313 Sherman Street <br />Denver, C) 80203 <br />This certificate is issued as a matter of information only and confers no rights upon the <br />certificate holder. This certificate does not amend, extend or alter the coverage afforded <br />by the policies listed above. <br />Countersigned By: <br />P. 0. Box 4454 <br />Madison, WI 53711 <br />Authorized Representative <br />608/273-1371 <br />Expiration Date <br />