REP14132

CERTIr.::.a: U INSURA:IC
S:; S.
CERTIFICATE HOLDER:
MINED LAND RECLAIMATION
ATTN MAGGIEE VAN CLEEF
1313 SHERMAN ST RM 215
DENVER CO 80203
TO WHOM IT MAY CONCERN:
This is to certify that this company has issued a Standard Workers' Compensation and Employers'
Liability Policy as described below covering the liability imposed upon subject employers by the
Workers' Compensation. Act of Colorado, said policy being in good standing as of this date.
POLICY NUMBER: 187841 -0 07/21/1992
POLICY PERIOD: 07/01/1992 TO 07/01/195:3
INSURED: AZCO CONST INC
1019 K STREET
PENROSE CO 81240
ORIGINAL EFFECTIVE DATE: 08/13/1986
(" SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL '-)
IMPORTANT: THE COVERAGE DESCRIBED ABOVE IS IN EFFECT AS OF THE ISSUE DATE OF THIS C'ERTIFICAT'E. IT IS
SUBJECT TO CHANGE AT ANY TIME IN THE FUTURE
All pclicies are subject to the following provision of the Workers' Compensation Act with respect to
cancellation:
Secticr. 8- 45 -..3. If any employer snall be in arrears for more than thirty days in any payment required
to be made by him to the Colorado Compensation Insurance Authority as provided oy this Act, he
shall by virtue of such arrearage be in default of suet payment and any policy issues to him by said
Authority shall :hereupon be cance!led without notice as of :he effective date or renewal date of saic
poiicy.
COLORADO COMPENSA ION INSURANCE AUTHORITY