GENERAL55215

• Permit No: C1980003
• IBM Index Class Name: General Documents
• Doc Date: 7/6/2001
• Doc Name: CERTIFICATE OF INSURANCE
• Permit Index Doc Type: INSURANCE
• Media Type: D
• Archive: No

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PRODUCEq THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
J8H Marsh 8 McLennan. Inc. xo RIGHTS UPON THE CERTIFICATE HOLDEq OTHER THAN THOSE PpOVIDED IN
1166 Avenue Df the Americas THE POLICY. THIS CERTIFICATE DOES NOT AMEND, E%TEND OR ALTER THE

New York. NY ]0036-2774 COVEMGE AFFORDED BY THE POLICIES LISTED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY
A CONTINENTAL CASUALTY CO
INSURED COMPANY
H-G COAL CO`1PANY a RECEIVI=n

C/0 W.R. GRACE 8 CO.
1 TOWN CENTER ROAD COMPANY
C
BOCA RATON, FL 33486

COMPANY
D
...
CO. ERAGES.".'.' :'::' :................:......................... :... .: :........:.....'.';'::,;.; ;..: ... '.;'.;.: .. ... ;. .....:.~IsB
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD IND ATED.
NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAV
BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS
OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS.
CO POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POIICY NUMBER DATE IMMIDD/YYI DATE IMMIDDM'I LIMITS
A GENERAL LIABILITY CCP 189]90695 6/30/99 6/30/00 GENERAL AGGREGATE • 2. D00. DDD
,~' , COMMERCIAL GENERAL LIABLITY PRODUCTS ~ COMPIOP AGG • 2, DDD. 000
CLAIMS MADE OCCUR PERSONAL b ADV INJURY • 2, DDD. DDD
OWNER'S b CONTRACTOR'S PROT EACH OCCURRENCE • 2, DDD. DDD
FIFE DAMAGE IAny one lirel
MED EXP IAny one persanl >
A AUT OMOBILE LIABILITY CCP 189190695 6/30/99 6/30/00
COMBINED SINGLE LIMIT •
X 1 ANV AUTO 2. DDD. DDD
1 ALL OWNED AUTOS
BODIIY INJURY
I
SCHEDULED AUTOS IPer person)
HIRED AUTOS
BODILY INJURY p
NON~OWNED AUTOS IPer accitlenll
T •
PROPER
Y DAMAGE
GgR AGE LIABILRY AUTO ONLY - EA ACCIDENT >
ANY AUTO OTHER THAN AUTO ONLY: ""
. .. .... .... .. .. .. ....
EACH ACCIDENT •
AGGREGATE
EXCESS LIABILRY EACH OCCURRENCE •
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FDRM
A WORKER'S COMPENSATION AND WC 189190650 6/30/99 6/30/00 X ORY IMITS OpH~ ~ :~:'. "::':.~:'.';';'; "; ';
~ ~
A EMPLOYERS'LIABILRY WC 189190678 - -- 6/30/99 - 6/30700
EL EACH ACCIDENT -
~
-2,x00;000
THE PROPRIETOR/
P
T INCL EL DISEASE -POLICY LIMIT ! 2, DDD. DDD
AR
NERRIEXECUTIVE
Of fICERS ARE:
EXCL
EL DISEASE - EA EMPLOYEE
> 2, DDD, DDD
OTHER
DESCRIPTION OF OPEIIATIONS I LOCATIONS /VEHICLES /SPECIAL REMS
The Coverage and Limits stated above apply to Pernlit No. C80-003.
CERTIFICATE:HOLDER ;' CANC,ALATtON `
~
SHOULD ANY OF THE POLICIES LISTED HEREIN BE CANCELLED BEFORE THE
EXPIRATION
DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL
C7V7S iGR Gf M7Rerd IS and 3O

GPO70gy DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT

1313 Sherman St.. Roan "115 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Denver. CO 80203 OF ANV KIND NSURER AFFORDING COVERAGE, ITS AGENTS OR
~
REPRESENTA
ES, R THE I UER O
F THIS CERTIFICATE.
_
A
JNH MARSH b CL NA I RA D
BY: ~~~/~~ ~~
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