PERMFILE110455

• Permit No: C1980003A
• IBM Index Class Name: Permit File
• Doc Date: 11/26/1996
• Section_Exhibit Name: 1996 RULE 2.03 PERMIT APPLICATION REQUIREMENTS
• Media Type: D
• Archive: Yes

C~
u
~~H ma~s>~ & m~>_>:Nlvari, wc. CERTlF1CATE OF INSURANCE
::. '
. ~'~. .~:.' :JNMMit21981.':: .. ...
6178199:::. .....:
__ ~ YAIm AS OFT'.':.:: ~;: . ~ ~ _
CEP LIFlCArE NUMBER _
M'~^Ol -00:-'i
PROOUCEP THIS CERTIFICATE I5 I$$UED A$ A MATTER OF INFORMATION ONL'/ AND CONFERS
%iri PIU I'bn i !trCL?Onall In[ NO AN3NT5 UPON THE LERTIFICA iE HOLDER OTHER 7HAN THOSE PRO VICED IN
//6b Avon!/4 7f ~!!? J,?.W,~IC~i THE POLICY. THIS CERTIFICATE DOES NOT AMEND. Ek'EVO OR ALTER THE

New Va'l. P1Y 1003E-:'774 COVERAGE AFFORDED HY THE POLICIES USTED HEgE1N.
_
I COMPANIES AFFORDING COVERAGE
I COMPAPIY
_ i A CGNTINE;VTAL CaSU,aLTY ~0
VlSUPED CCMPAIIV
H-, roaL CoaRaNY B ~~CEIV~

CiO IJ. R. G~acf 3 CO. ~__-_ _

1 TCW!v CENifR .ROAD COMPAIJY
C
BCCa IL1l2V. FL 33dS5 Ilf ~/-TF
~
~
CDI'dPANV
V
~
I~
COVERAGES :....:. :.::..::.: E21S:d1
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED HEREIN H AVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDI ATED.
NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORCED BY THE ACLIC:ES LISTED HEREIN IS SUBJECT 70 ALL THE TERMS. CONDITIONS AND EXCLUSIONS
OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS.
CO POLICY EFFECTIVE POLICY E%PIPATION
LTq TYPE OF INSURANCE I POUCY NUMBER DATE IMMIDDIYYI I GATE IMMI00/YY) I LIMITS
,4 GEN ERAL UABILT' CCP 189190695 6/30/99 6/30100 GENERAL AGGREGATE ~e 2.000.OOn
,~' COMMERCIAL GENERAL LIABILITY PgODUCT$ ~ COMPIOP AGG > 2.000. DOO
CLAIMS MADE nOCCUR ~ PERSONAL d ADV INJURY e z. 000. 000
OW NER'B 8 CONTPACTOR'$ PROT EACH OCCURPEIJCE e z. oQO. Gae
FIRE DAMAGE IAnY One lire) e
MEp E%P IAny one perspnl
q Aur amoelLE LIABIUrr CCP !89190695 6/30/99 5/30/00
e
.Y ANY AUTO COMBINED SINGLE LIMrt Z 000.OOI'
ALL OWNED AUTOS
BODILY INJURY
L
SCHEDULED PVTO$ IPer paspnl
HIRED AUTOS
BODILY INJVRY e
NON~OWNED aUT05 IPer accbenD
I
PR
PE
Y
e
I I I O
RT
DAMAGE
GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT i e
ANY 4UT0 OTHE.9 THAN AUTO ONLY: ~ ~~
~
I L EACH ACCIDENT e
I
AGGREGATE Ie I
Ek LESS LIABILTY I EACH OCCURRENCE e I
UMBRELLq FORM PGGREGA TE e I
OTHER THAN UMBRELLA FORM la I

A
WOR%ER'S COMPENSATION AND
+ W'C 18919G650
6/30/99
6/30/00 WC BTATU- 0TH,:
I X I TORY LIMIT$I I ER I^ ~ ~' '•~"':^ :~"' !

A EMPLOYERS' LIABILITY
WC 169i9G678
6/30/99
6/3U/UO r
EL EACH ACCIOEN7 ~e 2. GGG, QI"~
THE PRCPRIEiOR/
P
PT CJCL EL 015EASE- POLCY UMIi Ie 2. GGG. 0^"
A
NEP$IE%ECUTIVE
I OFFICERS ARE:
E%CL
EL DISEASE ~ EA EMPLOYEE ~e 2. GOO. GUI
OTHER i
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I SPECIAL ITEMS
The Coverage and !im(ts state0 above apply m Pe/Tnit N~. C80-003.
CERTIFICATE HOLDER ~~~.~ .- ~.. ~. ~.~. .. .. ~ . ~.. .~ .. : ~ CANCELLATION ~ ~: ~ ~..:~...~::. ~. ~ :... .~.. ~~::: .~ i
SHOULD ANY OF THE POLICIES LISTED HEREIN HE CANCELLED BEFORE THE EXPIRAI IL
DATE THEREOF, THE INSURER AFFORDING CO'/ERAGE WILL ENDEAVOR TO MAIL
Dlv)sion of Minerals and IT
3G
TT
Geology DAYS WRI
EN N071CE 7D 7HE CERTIFICA7E HOLDER NAMED HEREIN, BI
!313 Sh,. ^man SL.. ,4GV-I!! 21$ FAILURE TO MAIL SUCH NOTICE SHALL Ih1POSE NO OBLIGATION OR LIABILITY
Denver. CO 802OJ" OF ANV KIND NSURER AFFORDING COVERAGE, ITS AGENTS OR
REPRESENTA ES. R THE I UEfl QF THIS CERTIFICATE.
J6H MAq$H 8 LL NAN I O ORA D I L(.. ~,
BY: -
l -