PERMFILE139647

• Permit No: C1981031
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Section_Exhibit Name: Section 2: Rule 2.03
• Media Type: D
• Archive: No

_ +~.~,,~ ...t _
. - ~' }•~n111 fsYYI.37a1f;1^1~i1~iY.~iS ... ~ t~~;x
_ /
-, _ _
WrV1 ~./ ~ a r '.' ~` r
ice.
_

NAME AND ADDRESS OF AGENCY
'riountain States Special Plarket, Inc,. COMPANIES AFFORDING COVERAGES
through Dale Dodrill Insurance

858 S.. Radsworth Blvd „ Suite 302 COMPANY A
LETTER „ Rortheastern Fire Ins. Co, of PA
- +v0. Box 26166
COMPANY
Lakewood, CO 80226 LETTER
NAME AND ADDRESS OF INSURED A
COMPANY ^
LETTER V
Viking Coal Company
COMPANY D
P.O. BOX ~i LETTER
Aguilar, CO 81020
f COMPANY E
LETTER
This is to certity that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any rLquiremenL 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 tlescnbed herein is subject to all the
terms, exclusions and conditions of such policies.
Limlt§ Of Lla blll in Thousan § ( )
° COMPANY
LETTER TYPE OF INSURANCE POLICY rvUMBER POLICY
EXPIRATION DATE EACH AGGREGATE
OCCURRENCE
GENERAL LIABILITY
BODILY INJURY § S
^ COMPREHENSIVE FORM
PREMISES-0PERATION$ AGL 1H3O2 LO .Tan 82 PROPERTY DAMAGE § S
^ EXPLOSION AND COLLAPSE
HAZARD
A ^ UNDERGROUND HAZARD
^ PRODUCTS/COMPLETED
OPERATIONS HAZARD
© BODILY INJURY AND
CONTRACTUAL INSURANCE PROPERTY DAMAGE E 6Q0 S 600
^ BROAD FORM PROPERTY COMBINED `~
DAMAGE
^ INDEPENDENT CONTRACTORS i
^ PERSONAL INJURY
PERSONAL IN
JURY §
~~ AUTOMOBILE LIABILITY BODILY INJURY
S
~
(EACH PERSON) i
r
.~ •i ^ COMPREHENSIVE FORM BODILY INJURY S -~~'-' i=
~
~}
t'
"
'
t

^ OWNED (EACH ACCIDENT) ^_
_~,
.
--
.
:::
~

HIRED
PROPERTY DAMAGE
§ y
_'~_ ~._:
?' "ir':rt~.,~.-, s.

^ BODILY INJURY PND -~~. ~~"wi'~.q-
n
NON-0WNED PROPERLY DAMAGE § .- ~
COMBINED
EXCESS LIABILTY
BODILY INJURY AND
- ^ UMBRELLA FORM § S
^ OTHERTHAN UMBRELLA PROPERTY DAMAGE
COMBINED
FORM
u- WORKERS' COMPENSATION STATUTORY
4'
and
EMPLOYERS'LIABILRV ~~~~' ~~ty"•-~ §
(LKrv sCC1DFMT)
OTHER
. DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES
Mining of Coal
Cancellation: Should any of the above described polici es be cancelled before the expiration date thereof, the issuing com-
_ pany will endeavor to mail l~ days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligatio n or liability of any kind upon the company.
NAME AND ADDRESS OF CERLffICATE HOLDER: Q1?'L 0.02 2 19H1
°

'
~~ Mined Land Reclamation Board DATE ISSUED / ~
~
, ~
• State of Colorado ~
~
~
1313 Sherman Street ~'~~ - r/r ~-'e- /~~
Denver, CO 80203 AUTHORIZED REPRESENTATNE
*fo untain States Special ilarket, Inc.