PERMFILE124770

• Permit No: C1981029
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Section_Exhibit Name: 2.03.9 PERSONAL INJURY & PROPERTY DAMAGE INSURANCE INFORMATION
• Media Type: D
• Archive: No

,..
ISSUE DATE (MM/OD/Y Vl
OI .
1 ® y_ •lcln _
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION ONLY ANO CONFERS
• NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW
Flat Top Insurance Agency COMPANIES AFFORDING COVERAGE '
P. 0. Box 1439 ___ ---
Bluefield, ~ 24701 COMPANY A
LETTER
Old Republic Insurance Company ____

-__-- -.--- .. _._-_ _ _
COMPANY B
INSURED LETTER
San Call Co~TeIIy LETTERNY C .

5460 Ward Rd

$Ce 210-7 COMPANY'
LETTER ~ ~~RBVI$BDR
- -- --
Arvada, CO SOOO2 - -- _
COMPANY E
LETTER

THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM~OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. E%CLUSIONS. AND CONDI~
TIONS OF SUCH POLICIES. '
CO
TYPE OF
N vLL~i:. ;°IP~oI apLA;y I,gpApp, LIABILITY LIMITS IN THOUSANDS
LTR I
SURANCE POLICY NUMBER aLR IMM•W"'~I fLif IMM(MY~ ELp~

~.tC UUnLN~E AGGREGA?E
GENERAL LIABILITY _ _____
eooat
A COMPREHENSNEFDRM ZC46493 12/06/85 03/01/87 '""'R` $ 1,000 g 1,000,
PREMI$ESrOPERATIDN$ PROnERrv
UNDERGROUND ~ DAMAGE $ 1
000 OOD
$ 1

E%PLO$ION 8 CDLLAPSE HAZARD , ,
,
PRODUCTSCDMPLETED OPERATIONS
CDNiRACTUAL I COMBINED $ $
INDEPENDENT CONigpCi0R5

BROAD FDRM PROPERTY DAMAGE
i _
PERSONAL INJURY PERSONAL w.IURY $
.~Iy- .
AUTOMOBILE LIABILITY ! BW.•
vy

ANY AUTO
i , $
..vp aapT
ALL OWNED AUTOS IPRIV PA$$ I 3!U.'
OTHER THAN
ALL OWNED AUf05
~
~
~ i
.'Yo-
I x-+•%.:{'.'
PRIV PASS ;~_ -_
wRED AUiUS
I~^HO^ERT~'
NON~OWNEO AUiO$ ~ nl nu.GE $
L
GARAGE LIABIVTY ~
I ~ PI 6 vU
COMBINEDy

E%CESS LIABILITY
i
UMBRIILA {ORM I BI A PD
[(11A 01NEU pp C
~P i J
OTHER THAN UMBRELLA IORM I _ I

' y - -
-- ~rAt uiORr
WORKERS
COMVENSATION ~ $ ICAO ~CEIIR r:'~
AND ~ i g IUISELSI PIJI II'~'.IAtI;.
EMPLOYERS'LIABILITY
- ~
.___.._ g 11J5fa5C faf,H 'IF', ;,IY[[I
- __- __.
OTHER -_ _ _
A Gnvironmeatal I
_ _~mRsltment ZP0241 __ _ ___L 12/06185 _ ._ 03/OJ87 ~ . $1.,000,G00 _
DESCRIPTION OF OPERA710N$ILOCAiIONSNEHICLE$1$PECIAL rtEMG
• ,
orado Mined Laced Reclamation Division
423 Centennial Bldg
1313 Sherman St
Denver, CO 80203
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%
PIRA 710N DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL ) (~ DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO InE
LEFT. BUT'FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO ORLIGA iION OR LIABILITY
OF ANY KING UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES
'TMORIZED REPRESENTAi NE
_ 44 _ ~j ~a~ `Jai. .~n~l.crl,.¢hce ~]~;eFx:,sj