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,CERTIFICATE OF INSURANCE -WORKMEN'S COMPENSATION & LIABILITY ONLY <br />his certificate is issued as a matter of information only and confers nn rights upon the certificate holder. This certificate does not amend, <br />extend or alter the coverage aflorded by the policies li;fed below, <br />Job No. 5712 <br />Project Permit for Grassv GajLCoal Mining Location Routt County. Colorado <br />ownert.oloraao ueoarcmenti or rva>;ural resources, mtnea Lana reclama>;ton utvtston, Isis <br />Contractor Sherman St.. Denver, CO 80203 <br />Architect/Engineer __. <br />Insured The Rockcastle Company, P.O. Box 1038 ,lanesvillR. W1 53547 <br />Agent Cobb, Strecker, Dunphy & Zimmermann, Inc. Address 2702 International Lane. Madison. WI 5370,4 <br />WORKMEN'S COMPENSATION: <br />Policy <br />Insurance Company ~~r-4r~~VUr-~a~iun >.ruuran~c wmualry Address 1'~~~waunee. niawlu In <br />Coverage-Workmen's Compensation, Statutory. Employer's Liability Limit 51,000,000./$1.000.000./ each accident <br />PUBLIC LIABILITY: 1,000rOOO. <br />pnrcv No.- Cl~TJO 024 31 78 Effective 9/30/86 Expiration 9/30/87 <br />Insurance Company Transportation Insurance Company gddress Milwaukee. Wisconsin <br />Type of Policy: ®Comprehensive ^Other ~ - -~ ~ - ' - - - - -- - - - - <br />LIMITS <br />Bodily Injury $ Each Occurrence <br />$ Aggregate <br />Personal Injury $ Aggregate <br />COVERAGE PROVIDED (Check Applicable Squarel: <br />Operations of Contractor <br />Operations of Sub~Contractor (contingent) <br />Does Personal Injury include claims <br />related to employment? <br />Completed Operations/Produets~ <br />Contractual Liability (broad form] <br />Exceptions: <br />AUTOMOBILE LIABILITY: <br />Etfecti <br /> Property Damage $ Each Occurrence <br /> $ Aggregate <br /> -OR - <br /> CombinedSingleLimit $ 1,000,000. Each Occurrence <br />Yes No Yes No <br />® ^ Governmental Immunity is waived ^ <br />® ^ Properly Damage liability includes: <br /> Damage due to blasting © ^ <br />0 ^ Damage due to collapse ® ^ <br /> ^ Damage to underground facilities ® ^ <br />® ^ Broad Form Property damage ® ^ <br />9/30/87 <br />Policv No. 31 79 Etlective 9/30/86 _ Expiration 9/30/87 <br />Insurance Company Transoortation Insurance Companv Address Milwaukee, Wisconsin <br />Type of Polley: ®Comprehensive ^Other <br />LIMITS: <br />Bodily Injury: $ Each Person - Ofl - <br />$ Each Occurrence ~ Combined Single Limit $ 1 , 000, 000. Each Occurrence <br />Property Damage $ Each Occurrence Yes No <br />Coverage is Drovided for operation of all owned, hired and non owned vehicles ® ^ <br />UMBRELLA EXCESS LIABILITY INCLUDING AUTOMOBILE LIABILITY: <br />Policy No <br />Insurance <br />LIMITS: <br />Single limit Bodily Injury <br />and Property Damage $, 1, 0001000. Each Occurrence <br />Yes No <br />COVERAGE PROVIDED: Applies in excess of the coverages listed above for Enployer's liability, Public Liability <br />and Automobile~Liability SUBJECT TO THE TERMS OF THE POLICY. ® ^ <br />Are any deductibles applicable to bodily injury or property damage on any of the above coverages? II so, list. ^ <br />AGENT CARRIES ERRORS AND OMISSIONS INSURANCE ® ^ <br />Should any of the above described policies be cancelled belore the expiration date tlsereol, the issuing company will endeavor to mail <br />fifteen days written notice to the tye'fdtdUlfyfl0tltcertilicate holder, but lailure to mail such notice shall impose no obligation or liability of <br />any kind upon the company. ~ A <br />Dated at Madison, Wisconsin on 6/8/87 ey ~(~rr... w~ ~11~ <br />uthori7ed Insurance Representative <br />Construction Indurtry Cooperative Commil,ee of Minnesota -Form C.I,C.C.~701, Feb. 7961, Rev. June 1969, Rev. Jan. 19]1, Rev. Nov. 1077 <br />Printed by H. A. Roqers Co., X777 Wavrata Blvd.. MpH.. 55405. ]774670 <br />