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

CXOfU . • ,
• ~ •. ~ •
NAMf AND ADDRESS Of AGENCY ~
yyer Agency
08 Main
Wrlsanburg, Colorado 81089
NAME AND MAILING ADDRESS OF INSURED
American Fuale jsc.
P, U, Box 511
Aguilar, Colorado 81020
St, Paul Insurened
Effective 12 :OlA m 9/11 ,19 a3
Expires fY 12:01 am ^ Noon 101 , 19 8:
D This binder is issued to extend coverage in the above
company per expiring policy N ,_ _ _ _ _. W .,
C•®1 Strip Mine
7271 Terax Front Endloader X75,000
Type acrd Location of Property Coverage/Perils/Forms Amt ar tnaurarxa Dad. r°x~'A
P
R 7271 Tar ax Front rhdloader All Riak X75,000 100
p Offioe Fire, ESEt. Coveraga,V 12,000 100
p Contents Fire, Ext. Covaro(~a &
E Vtnm 12,000 100
R
T
Y
T
1 I /F
C Limits of Liabilit
ype o
nsurance overage
orms
L Each Occurronce Ie ate
I ^ Scheduled Form CfComprehensive Form Bodily Injury $ $
A ^ Premises/0perabons Property
^ Products/Completed Operations Damage $ $
l ^ Contractual Bodily Injury &

T d Oiher (specify below) Property Damage
00
500
500
000
O Med. Pay $ o.r $ Pei mbrne , ,
Y Perron AttMent
^ Personal Inlury
^ A ^ B O C
Persona
l Injury
$
A Limits of Liabili
U ~ L~abdrty ^ Norrowned ^ Hired Bodily Injury (Each Person) $
T ^ Comprehensive-Deducbble $ Bodily Injury (Each Accident) $
0 ^ CDllrsron-Deductible $

M
0
^ Medical Payments $ -
Property Damage $
^ tJnmsured MotoNSl $
g
t ^ No fault (speufy}: Bodily Inlury & Property Damage
L ^ Uther (specityy Combined $
E
^ WORKERS' COMPENSATION -Statutory Limits (spec+fy states below) d EMPLOYERS' LIABILITY - LRnit $ ~'
SPECIAL CONDITIONS/OTHER COVERAGES
NAME AND aDURESS OP LJ MORTGAGEE U LU55 PAYEE U AUO'E INSURED
LOAN NUMBER

r Agency by
~-.
_~ ~, ._.. _~~-~~l_.____. l_
Signature of Authw i. r.U Rcl rcein:alrvr IDa_te
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