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2007-08-20_GENERAL DOCUMENTS - C1981013
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2007-08-20_GENERAL DOCUMENTS - C1981013
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Last modified
8/24/2016 3:17:42 PM
Creation date
8/11/2009 9:39:59 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981013
IBM Index Class Name
General Documents
Doc Date
8/20/2007
Doc Name
Certificate of Liability Insurance
From
Acord
To
DRMS
Permit Index Doc Type
Insurance
Email Name
DAB
Media Type
D
Archive
No
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<br />ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 8/20/2007 <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 />865-251.5270 INSURERS AFFORDING COVERAGE <br />INSURED /j? Of , . INSURER A NATIONAL UNION FIRE INS. CO. OF PITTSBURGH PA <br />BASIN RESOURCES, INC. o'/j? INSURER e: <br />2 NORTH CASCADE AVE., 3RD FLOOR atSTa `` INSURER C: <br />f <br />COLORADO SPRINGS, CO 80903INSURER D: <br />INSURER E. <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 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 CERT WICATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IIy,R <br />LTA <br />TYPE CF INSURANCE <br />POLICY NUMBER POLICY EFFECTIVE <br />DATE WMOD'YY) POLICY EXPIRATION <br />DATE (MVDO" <br />LIMT9 <br /> GENERAL LIABILITY EACH OCCURRENCE $1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (ANY ONE FIRE) .$550,000 <br /> CLAIMS MADE mX OCCUR GL643-18-68 7/l/2007 7/112008 MED EXP (ANY ONE PERSON) $5,000 <br /> PERSONAL & ADV. INJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMITS APPLES PER: PRODUCTS - COMP/OP AGG $2,000,000 <br /> X POLICY PROJECT LOC <br /> AUTOMOBILE LIABILITY <br />ANY AUTO COMBINED SINGLE LIMIT <br />(Each Accident) <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per Person) <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per Accident) <br /> PROPERTY DAMAGE <br /> (Per Accident) <br /> GARAGE LIABILITY AUTO ONLY- EACH ACCIDENT <br /> ANY AUTO OTHER THAN EA. ACC. <br /> AUTO ONLY: AGG. <br /> EXCESS LIABILTY EACH OCCURRENCE <br /> OCCUR ? CLAIMS MADE AGGREGATE <br /> <br /> DEDUCTIBLE <br /> RETENTION E <br /> WORKERS COMPENSATION AND WC STATUTORY LIMITS <br /> EMPLOYERS' LIABILITY OTHER <br /> E.L. EACH ACCIDENT <br /> E.L. DISEASE - EA EMPLOYEE <br /> E.L. DISEASE - POLICY LIMIT <br /> OTHER <br />DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES/EXCLUSK)NS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />RE: THE GOLDEN EAGLE MINE PERMIT #C-81-013 <br />CERTIFICATE HOLDER ADDITIONAL INSURED: INSURER LETTER: CANCELLATION <br />STATE OF COLORADO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE <br />MINED LAND RECLAMATION OFFICE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30' DAYS WRITTEN NOTICE TO THE <br />ATTN: JOSEPH DUDASH CERTIFICATE HOLDER NAMED TO THE LEFT. <br />1313 SHERMAN STREET, ROOM 215 <br />DENVER, CO 80203 AUTHORIZED REPRESS <br />ACORD 25-S(WI) '10 DAYS FOR NONPAYMENT OF PREMIUM
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