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2008-10-15_GENERAL DOCUMENTS - C1981010
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2008-10-15_GENERAL DOCUMENTS - C1981010
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Last modified
8/24/2016 3:37:08 PM
Creation date
10/15/2008 2:38:19 PM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981010
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
10/15/2008
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JDM
Media Type
D
Archive
No
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DATE (M <br />M/DD/YYYY, <br />ACOR0_ CERTIFICATE OF LIABILITY INSURANCE <br />1 <br />0/01/ <br />10/01 /2008 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />MARSH USA INC. <br />1225 17TH STREET <br />SUITE 2100 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />, <br />DENVER <br />CO 80202-5534 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />, <br />Attn: Denver <br />CertRequest@marsh <br />com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />. <br />. <br />S67982-00125-ALL-08-09 <br /> INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />TRAPPER MINING, I may',\tl INSURER A: Great Northern Insurance Company 20303 <br />PO BOX 187 °.r INSURER B: N/A N/A <br />CRAIG, CO 81626 <br />(? <br />5 ?O INSURER C: <br /> <br />vv INSURER D: <br />eC`?? <br />Y INSURER E: <br />C0VFROGFS _ .:. YoV 1-C LIJICU 6CLUVV MAVt tsttly ISSULU To THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH <br />IS CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS <br />EXC <br />, <br />LUSIONS AND <br />CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INS <br />LTR ADD' <br />INSR TYPE OF INSURANCE POLICY NUMBER OLICY EFFECTIVE POLICY EXPIRATION <br />LIMI <br /> DATE (MM/DD/YY) DATE (MM/DD/YY) TS <br /> GENERAL LIABILITY EACH OCCURRENCE 1,000,00( <br /> <br />A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 <br />000 <br />00 <br />$ <br /> 37100018 10/01/08 10/01/09 PREMISESEaoccurence , <br />, <br /> CLAIMS MADE [A] OCCUR MED EXP (An <br />one <br />er <br /> y <br />p <br />son) $ 10,00 <br /> <br /> PERSONAL & ADV INJURY $ 1,000,00C <br /> GENER 2 <br /> <br />GENERAL AGGREGATE LIMIT APPLIES PER AL AGGREGATE $ <br />,000,00 <br /> X POLICY PECT LOC PRODUCTS -COMP/OP AG 2,000,00 <br /> <br /> AU TOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br />$ <br /> ANY AUTO (Ea accident) <br /> ALL <br />W <br /> O <br />NED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br /> BODILY INJURY $ <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident)' $ <br /> , <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: $ <br /> AGG <br /> EXCESS/UMBRELLA LIABILITY <br /> EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE <br /> $ <br /> RETENTION $ <br /> WORKERS COMPENSATION AND WC STATU- OTH- <br /> EMPLOYERS' LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br />L. EACH ACCIDENT <br />$ <br /> OFFICER/MEMBER EXCLUDED? <br />If L. DISEASE - EA EMPLOYE $ <br /> yes, describe under <br />SPECIAL PROVISIONS below <br />L. <br />DISEASE -POLICY LIMIT <br /> <br />$ <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />RE: PERMIT #C-81-010 <br />POLICY INCLUDES COVERAGE FOR PROPERTY DAMAGE AND PERSONAL INJURY RESULTING FROM THE USE OF EXPLOSIVES <br />INSURER WILL <br />. <br />NOTIFY DIVISION WHENEVER SUBSTANTIVE CHANGES ARE MADE IN THE POLICY INCLUDING ANY TERMINIATION OF FAILURE TO RENEW. <br />CERTIFICATE HOLDER SEA-001241399-15 CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />COLORADO DIVISION OF RECLAMATION EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL WWP&X yP MAIL <br />AND SAFETY DEPARTMENT OF NATURAL RESOURCES 30 DA <br /> <br />1313 SHERMAN STREET- ROOM 215 YS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />DENVER, CO 80203 CYeX )16D(XD6>e6EQi6DCA?GA6DfOQ516 <br />D <br />lPd <br />bD <br />C <br />X <br />XaC?3E?CXX ROAK ?CXXXW ?19(p( . <br /> ?1 <br />? <br />E <br />p <br />pE <br />AOf MaBh USAP? PRESENTATIVE ?Q-i-G+v Q -??YQ v <br /> Sharon A. Hammer <br />---- - J" --j O ACORD CORPORATION 1988
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