2008-06-06_GENERAL DOCUMENTS - C1996083 ‎(2)‎

• Permit No: C1996083
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 6/6/2008
• Doc Name: Certificate of Liability Insurance
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: JJD
• Media Type: D
• Archive: No

THIS ISTOCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERMOR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTWITH RESPECTTO WHICHTHIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO POLICY EFFECTIVE POLICY EXPIRATION

LTR TYPE OF INSURANCE
- POLICY NUMBER
DATE (MWDDIYY)
DATE (MMIDDIYY) LIMITS
A GEN ERAL LIABILITY 6464602 5/31/08 5/31/09 GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 1,000,000
CLAIMS MADE X-] OCCUR PERSONAL & ADV INJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
X Blasting- - -
FIRE DAMAGE (Any one fire)
$
MED EXP (Any one person) $ 5,000
AUTOMOBILE,LIAB ILITY
E `.'
__ __
..._-._. .._. .-..

."_
COMBINED SINGLE-LIMIT

.$__.
ANY AUTO
OWNED AUTOS
ALL - - ------ -- - BODILY INJURY ... .?-.
,
:
•
(Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE Is
GARAGELIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
_ AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
-- - $
- `
-OTHER -THAN-UMBRELLA-FORM-._ - - - _
WORKERS COMPENSATION AND WC STATU- OTH-
TORY LIMITS ER

EMPLOYERS' LIABILITY __

EL EACH ACCIDENT

$
THE PROPRIETOR/
E INCL EL DISEASE-POLICY LIMIT $
PARTNERS /
XECUTIVE
OFFICERS ARE:
EXCL
EL DISEASE-EA EMPLOYEE
$
OTHER
DESCRIPTION OF OPERATIONSILO CATIO NSIVEH ICLESISPECIAL ITEMS
Bowie #2 Nine Permit #C-096-083. General Liability Policy provides protection for use of explosives.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
State of Colorado -..EXPIRATION DATE THEREOF, THE ISSUING COMPANY YAMMOtlfN II(NNI X NO(CXX
Division of Reclamation, 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Mining and Safety 10)(fX?G10KtlN1EXOtX)iMA(K?OtlHX00m(OEKk?H(ItlX)(Mltl(dfIIKX)lX)tld(XdfXXWIfI(XiH(K1f9dIKN)h(X
1313 Sherman Street, Room 215 CWX)G10f(XX)NN(O XXWA)MXNXGFXX9tl(IRF1lU MXXXXXA)MC 1 M)(§(RX)HHHHd RKDOM)W(9f.
Denver, CO 80203 AUTHORIZED REPRESENTATIVE
YN-161 o PAW INSURANCE SERVICEMM.•IM t I o.k, AA I , CP Iw
LEHIIFILAI[: UIUIUUI/ UUU%D