My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2007-12-03_GENERAL DOCUMENTS - C1981025
DRMS
>
Day Forward
>
General Documents
>
Coal
>
C1981025
>
2007-12-03_GENERAL DOCUMENTS - C1981025
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/24/2016 3:18:59 PM
Creation date
12/4/2007 2:17:09 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981025
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
12/3/2007
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
Client#~ 123795 <br />35SRHO1 nl <br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE 11/29/07Dnrrv) <br />PRODUCER, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />HUB SW Grand Junction CL O <br />2742 Crossroads Blvd ~~ <br />~~ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />P.O. Box 60130 G <br />Grand Junction, CO 81506 ~~ OQ1 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />~ EMC Insurance Companies 999999 <br />S & B Holdings LLC, Minrec, Ilp~ <br />' ~~~s ,~,~ <br />~ 2 INSURER B: <br />2024E 3/4 Road o~ <br />ara <br />`°` INSURER C: <br />~~o <br />Grand Junction, CO 81503 ~~~~ <br />J ~~~ <br />`~~ INSURER D: <br />~ <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FOLIC Y 'F.RIpG ~NDICP.TED NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI`~ CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. E:(CLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />S POLICY EFFECTIVE POLICY EXPIRATION <br /> <br />LTR <br />NSR TYPE OF INSURANCE POLICY NUMBER <br />DATE MM/DD/YY <br />DATE MMIDD/YY LIMITS <br />A GENERAL LIABILITY 3X64904 09/01/07 09/01/08 EACH OCCURRENCE $1 000000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br />P I ur en $100 000 <br /> CLAIMS MADE ~ OCCUR MED EXP (Any one person) $5 000 <br /> PERSONAL & ADV INJURY $1 000 000 <br /> GENERAL AGGREGATE $2 000 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2 000 000 <br /> PRO <br /> POLICY <br />LOC <br />JECT <br />A AUTOMOBILE LIABILITY 3X64904 09/01/07 09/01/08 COMBINED SINGLE LIMIT <br /> <br />(Ea accidenq $1000000 <br />~ ~ <br /> ANY AUTO <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> X HIRED AUTOS <br />BODILY INJURY <br /> <br />X <br />NON-OWNED AUTOS <br />(Per accident) $ <br /> PROPERTY DAMAGE <br /> <br />(Per accident) $ <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S <br /> <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WC STATU- OTH- <br /> WORKERS COMP-ENSAIlON AND. -__- _--_ _ _ _. _ ~ _ __ _ _ __ __ _ <br /> EMPLOYERS' LIABILITY <br /> E.L. EACH ACCIDENT $ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ <br /> OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Re: North Thompson Creek Mines, DRMS Permit C-1981-025. State of <br />Colorado, Division of Reclamation Mining & Safety is included as an <br />Additional Insured. *Except 10 days notice due to non-payment of premium. <br />GERTIFIGATE HOLDER C:ANI:tLLA I IUN <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />State of Colorado DATE THEREOF, THE ISSUING INSURER WILL jZgjpRRq~ MAIL 3n* DAYS WRITTEN <br />Division of Reclamation Mining & Safety NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Jl~RR94p1N~E>OJPJAQi~QC9l'~4Cx <br />1313 Sherman St, Rm #215 1M007dR1i&J0J8lQJGARRD~JQRxfN61C)IDC7WFXUYXXKJfPXDFIGRRX6(CW[D(B~CR70616iLCC66Xx~(XX <br />Denver, CO 80203 Rl:~asxxu~rwxxx <br />AUTHORIZED <br />ACORD 25 (2001/08) 1 of 2 #S2855/M2850 ACK ©AGORD GORPUKA I IUN IyBS <br />
The URL can be used to link to this page
Your browser does not support the video tag.