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2009-06-04_GENERAL DOCUMENTS - C1980004
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2009-06-04_GENERAL DOCUMENTS - C1980004
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Last modified
8/24/2016 3:47:16 PM
Creation date
6/5/2009 8:48:30 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980004
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
6/4/2009
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
MPB
Media Type
D
Archive
No
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O DATES/30//YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />05/30/2009 <br />PRODUCER <br />Aon Risk Insurance Services West, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />Fresno CA Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />5260 North Palm Avenue CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />Suite 400 COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Fresno CA 93704 USA <br />PHONE-(559) 449-7200 FAX-(559) 439-0863 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED ® INSURER A: National union Fire ins Co of Pittsburgh 19445 <br />McClane canyon mining LLC <br />INSURER B: <br />P . O. BOX 1169 <br />Pikeville KY 41502 u5 9 <br />INSURER C: <br />\\\? 41,?? 'oor, INSURER D: <br />J? 2iG\a INSURER E: <br />rnVFRAC..FC <br />THE POLICIES OF INSURANCE LISTS E BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITIO F ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED <br />INSR ADD' <br />LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> DATE(MM/DD/YYYY DATE(MM/DD/YYYY) <br />A GENERAL LIABILITY. GL0936045 05/31/2009 1210112010 EACH OCCURRENCE $1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000 <br /> <br />CLAIMS MAUL <br />OCC PREMISES (Ea occurrence) <br /> a <br />UR MED EXP (Anv one person) <br /> PERSONAL &ADV INJURY $1,000 <br />000 <br /> F] , <br /> GENER <br />L <br />GGR <br /> A <br />EG.ATE <br />A $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER <br /> PRODUCTS - COMP/OPAGG $2 <br />000 <br />000 <br /> ? POLICY ? PRO ? <br />X LOC , <br />, <br /> JECT <br />A AUTOMOBILE LIABILITY CA0935830 05/31/2009 1210112010 <br /> COMBINED SINGLE IJMIT <br /> X ANYAU10 (T_zacculen) $1,000,000 <br /> ALL OWNT_D AUTOS <br /> BODILY INJURY <br /> SCHEDULED :AUTOS ( Per person) <br /> X HIRED AUTOS <br /> BODILY INJURY <br /> X NON 0l1RJED AUTOS IPer acodcnO <br /> PROPERTY DAMAGE <br /> P <br /> (Per accident) <br /> GARAGE LI:ABILITI AUTO ONLY- EA ACCIDLNT <br /> AN\'AUTO <br /> OTHER THAN EA ACC <br /> AUTO ONLY <br /> AGG <br /> EXCESS/ UMBRELLA LIABILITY EACH OCCURRENCE <br /> <br /> ? OCCUR ? CLAIMS MADE AGGREGATE <br /> <br /> DEDUCTIBLE <br />- <br /> - <br /> - ETENTIO <br /> WC STATU- OTH- <br /> WORKERS COMPENSATION AND <br />Y/NN' <br />' <br />TORY LIMITS <br />ER <br /> EMPLOYERS <br />LIABILITY <br />ANY PROPRIETOR / PARTNER / EXECUTIVE ? G.L. EACH ACCIDENT <br /> <br /> OFFICE R/MEMBER EXCLUDED E.L. DISEASE-EA EMPLOYEE <br /> (Mandatory in NH) <br /> G.L. DISEASE-POLICY LIMIT <br /> Ifyes, describe under SPECIAL PROVISIONS below <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />McClane canyon mine, Permit No. C-1980-004 <br />L <br />u <br />C <br />d <br />L <br />O <br />O <br />to <br />6\ <br />O <br />V <br />M <br />O <br />0 <br />n <br />C <br />z <br />a <br />v <br />L <br />L <br />.j <br />y <br /> <br />CERTIFICATE HOLDER CANCELLATION <br />Division of Reclamation, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />Mining and Safety DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR -Te MAIL <br />1313 Sherman St., Room 215 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. <br />Denver CO 80203 USA s PSr E <br />I AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserve <br />The ACORD name and logo are registered marks of ACORD
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