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9/2/04 Time: 11:07 AM To: @ 9303-832-8106 <br />Pinnacol Assurance Page: 002-003 <br />21t.. <br /> <br />. <br />n .. . . <br />.......................................................................... <br />............................................................................. <br />- - - - - - - - - - - - - - - - - - - - - <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />PRODUCER <br />Pinnacol Assurance AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />7501 E Lowry Blvd CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE <br />DENVER CO 80230-7006 AFFORDED BY THE POLICIES BELOW. <br /> COMPANIES AFFORDING COVERAGE <br />it <br />11 <br />COMPANY <br /> A Pinnacol Assurance <br />INSURED COMPANY <br />i <br />CAT'S BACKHOE SERVICE LTD <br />B <br />486 E GENTRY DR COMPANY <br />PUEBLO WEST CO 81007 C <br /> <br /> COMPANY <br /> <br />II D <br />................................................................ <br />............................::::::•::::::::::::::•:::::::::.:•::::.:::::::::::::.•:::::::.:•::•:::::.•::::•:::::•: a•»::•::•:::•::: <br />................. ................................................................ <br />... <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, <br />NOTWITHSTANDING ANY REQUIREMENT, TERM AND CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS <br />OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> TYPE OF INSURANCE POLICY NUMBER POLCYEFPECTIVE POLICY EXPIRATION LIMITS <br /> DAT dd/ DATE(-Wdd/mv) <br /> GENERAL LIABILITY GENERALAGOREGATE <br />f <br /> COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGO <br /> CLAIMS MADE 0 OCCUR PERSONAL & ADV INJURY <br /> <br /> OWNER'S & CONTRACrOR'S PROT EACH OCCURRENCE <br /> <br /> FIRE DAMAGE (AT oro Rre <br /> MED EXP (Ay oro ,,- <br /> AUTOMOBILELIABILITY <br /> ANY AUTO COMBINED SINGLE LIMIT <br /> <br /> ALL OW NED AUT OS BODILY INJURY <br /> SCHEDULEDAUTOS r rwn <br /> , <br /> HIRED AUTOS BODILY INJURY <br /> OWNED AUTOS <br />NON r accident <br /> - I <br /> i <br /> <br />I <br />PROPERTY DAMAGE <br /> GARAGE LIABILITY ' AUTO ONLY - EA ACCIDENT <br /> ; <br /> ANY AUTO OTHER THAN AUTO ONLY: <br /> <br /> EACH ACCIDENT <br /> AGGREGATE <br /> EXCESS LIABILITY E4C41 OCCURRENCE <br /> ? <br /> UMBRELLA FORM ? AGGREGATE <br /> <br /> OT HER THAN UMBRELLA FORM <br /> WORKERS COMPENSATION AND WCSTATU- OTHER <br /> EMPLOYERS' LIABILITY TORY LIMITS <br />A 4062637 06/21/2004 10/01/2004 ELEACHACCIDENT $100,000 <br /> PARTNERS <br />THE PROPRIETOR INQ EL DISEASE - POLICY LIMIT 500000 <br /> / <br />/ <br />EXECUTIVE OFFICERS ARE: . <br />EXCL EL DISEASE - EA EMPLOYEE A100,000 <br /> <br /> OTHER <br />DESCRIFr ION OF OPERATIONS/L.OCATIONS/VEHICLMISPF.CIAL ITEMS <br />SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL <br /> <br />782062 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />THE COLORADO DIVISION OF MINERALS AND GEOLOGY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />GARY CURTISS 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />1313 SHERMAN STREET ROOM 215 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR <br />DENVER CO 80203 LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> My Dung Cao <br /> Underwriter <br />.............................................:........................... . <br /> ........ <br />.......... <br />ELSTERE CSR Sryporl 09,02rt1411:1192 408207 Upd.led: 12/15/19961290:00 UW135