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10 OE 01 09:34 CENTENNIAL INS 4 8523759 N0.336 D02 <br /> OVA- SURETY 9M Transaction Report & Involce <br /> CNA SURETY Principal Information: ID: 000140536 <br /> 101 SO. PHILLIPS AVENUE MATHIAS CONCRETE, INC <br /> SIOUX FALLS, S.D. 57192 P. 0. BOX 266 <br /> MONTE VISTA, CO 81144 <br /> Agency Code: 05-00324 <br /> CENTENNIAL AGENCY INC <br /> P 0 BOX 8210 <br /> PUEBLO CO 81008 <br /> Trenaactlon Description: RENEHAL Transaction Effective pate: 0412212001 <br /> NUmtMT: 10 218 780 7 BE FMP <br /> Wntien BY: CONTINENTAL CASUALTY COMPANY <br /> Description SAND A GRAVEL RECLAMATION BOND - O'B►NNON PIT, PERMIT ND. M-80-201 <br /> CtAgee STATE OF CDLORXW <br /> MINED LAND RECLAMATION DIV. PREMIUM 9217.00 <br /> DEPT, OF NATURAL RESOURCES <br /> 1513 SHERMAN STREET, ROOM 215 <br /> DENVER, CO 00293 <br /> Effective Date: 04-22-2001 <br /> Expiration Date: 04.22.2002 <br /> Current Penalty: 019,R00.00 <br /> Renewal Method: INvoicE <br /> Change Detall: RECL I V C <br /> JAN 2 9 2001- <br /> Centennial Insurance <br /> I <br /> Aar You MO Daly u u%%A*o bDhnV med4 lnuopa <br /> -------- -----------------------------------------------------------........-.----.____--___--_____-______-__----.----._____----.............- -------- <br /> WA SURETY9M INVOICE <br /> 'RE NO. I EFF0ECTIVE DAT1E ANNIVERSARY DATE I PROCESS 3DA0TE I PENALTY <br /> -2 - 1 <br /> 0605 142187847 04-22-02 .410p 00 <br /> PRINCIPAL MA H1I S CUKRETE, INC <br /> P. 0. BOX 266 MONTE VISTA, CO 81144 <br /> RISK STATE COF• DE FMP <br /> DESCRIPTION SAND @ GRAVEL CLA N - 0 AN ON T, PER T M-80-201 <br /> OBLIGEE <br /> AGENCY CODE <br /> 05-00324 CHARGE $217 . 00 <br /> Your ABsnlq <br /> RECEIVED <br /> CENTENNIAL AGENCY INC OCT ^C 20U1 <br /> P O BOX 5210 <br /> PUEBLO CO 81008 <br /> Division of Minerals and Ge9logy <br />