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2008-06-27_GENERAL DOCUMENTS - C1981013
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2008-06-27_GENERAL DOCUMENTS - C1981013
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Last modified
8/24/2016 3:33:38 PM
Creation date
7/1/2008 11:04:38 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981013
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
6/27/2008
Doc Name
Certificate of Liability (Faxed)
Permit Index Doc Type
Insurance
Email Name
KAG
Media Type
D
Archive
No
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JUNa27-2008 16:33 HRH of Tennessee, Inc. P.02 <br />ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 6/2612008 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS <br />HILB ROGAL AND HOBBS OF TENNESSEE, INC. NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, <br />120 MARKET PLACE BLVD. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />KNOXVILLE. TN 37922 <br />865-251-S270 <br />INSURERS AFFORDING COVERAGE <br />INSURED INSURER A: NATIONAL UNION FIRE INS. CO. OF PITTSBURGH PA <br />BASIN RESOURCES, INC. INSURER B: <br />2 NORTH CASCADE AVE., 3RD FLOOR INSURER C: <br />COLORADO SPRINGS, CO 80903 INSURER D: <br /> INSURER E: <br />COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM <br /> OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES <br /> DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES <br /> <br />NSR . AGGREGATE LIMI TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />. <br /> <br />LTR <br /> <br />TYPE OF INSURANCE <br /> <br />POUCY NUMBER <br />POLICY EFFECTIVE <br />DATE (MIWOD.'YYI <br />POLICY E%PIRq T10N <br />DATE IIAeDONYI <br /> <br />LIMITS <br /> <br />A GENERAL LIABILITY EACH OCCURRENCE $1,0M.000 <br /> X COMMERCIAL GENERAL LIABILITY ~ <br /> FIRE DAMAGE (ANY ONE FIRE) $50 000 <br /> CLAIMS MADE = OCCUR GL643-18-68 711/2008 <br />7//2009 <br />MEO EXP (ANY ONE PERSON) <br />,$rj QQO <br /> X Includes Bodily Injury <br /> <br />X <br />Includes PruN FIIDpeRy Damage PERSONAL B, ADV. INJURY $1.000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GENL AGGREGATE LIMITS APPLIES PER: <br /> PRODUCTS - COMPIOP AGG $2 <br />000 <br />000 <br /> X POLICY PROJECT LOG , <br />, <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO <br /> (Each Accident) <br /> ALL OWNED AUTOS <br /> BODILY INJURY <br /> SCHEDULED AUTOS <br /> (Per Person) <br /> HIRED AUTOS <br /> BODILY INJURY <br /> NON-OWNED AUTOS <br /> (Per Accident) <br /> PROPERTY DAMAGE <br /> IN, Accident) <br /> GARAGE LIABILITY <br /> AUTO ONLY - EACH ACCIDENT <br /> ANY AUTO <br /> <br />H OTHER THAN EA. ACC. <br />- . AUTO ONLY: AGG. <br /> EXCESS LIABILITY <br /> EACH OCCURRENCE <br /> OCCUR a CLAIMS MADE AGGREGATE r <br /> <br /> DEDUCTIBLE <br /> <br /> RETENTION S <br /> WORK ERS COMPENSATION AND <br /> WC STATUTORY LIMITS <br /> EMPLOYERS' LIABILITY <br /> OTHER <br /> E.L. EACH ACCIDENT <br /> El. DISEASE - EA EMPLOYEE <br /> E .L. DISEASE - POLICY LIMIT <br />O THER <br /> <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS <br />RE: THE GOLDEN EAGLE MINE PERMIT #C-81-013 <br />CERTIFICATE HOLDER ADDITIONAL INSURED? INSURER LETTER' CANC EL <br />ON <br />=JOSEPHDUDASHH ADO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE <br />AMATION OFFICE THEREOF. THE ISSUING INSURER WILL EHB6AVQR-T0 MAIL 70' DAYS WRITTEN NOTICE TO THE <br />DASH CERTIFICATE HOLDER NAMED TO THE LEFT. <br />REET, RO OM 215 MR WAS' <br />3 AUTHORIZE FIRES <br />A <br />ACORD 25-S(6101) '10 DAYS FOR NONPAYMENT OF P EMIUM ?'?
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