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2009-08-13_GENERAL DOCUMENTS - C1992080
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2009-08-13_GENERAL DOCUMENTS - C1992080
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Last modified
8/24/2016 3:49:44 PM
Creation date
8/14/2009 1:23:39 PM
Metadata
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Template:
DRMS Permit Index
Permit No
C1992080
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
8/13/2009
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
TAK
Media Type
D
Archive
No
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j <br />ACORD <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) <br />r. 8/10/2009 <br />PRODUCER Phone: 940-723-0771 Fax: 940-761-5280 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Allred-Thompson-Mason-Daugherty Ins. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />A Division of Higginbotham Insurance Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />1300 10th Street <br />Wichita Falls TX 76307 <br /> INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURERA: Mid- Continent Casualty Com an 23418 <br />Oakridge Energy Inc. Pueblo Mining, Inc. INSURERB:Texas Mutual Insurance Com an <br />4613 Jacksboro Hwy <br />Wi <br />hit <br />F <br />ll <br />TX 76302 NSURERC: <br />c <br />a <br />a <br />s <br /> INSURER D: <br /> INSURER E: <br />CAVFRA11FS <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 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 THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD'L <br />LTR NSRI <br />TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE <br />DATE (MMIDDrrn POLICY EXPIRATION <br />DATE MM LIMITS <br />A GENERAL LIABILITY 04GL000739532 12/5/2008 12/5/2009 EACH OCCURRENCE $1,000.000 <br /> TORENTED <br />M <br />E <br /> X COMMERCIAL GENERAL LIABILITY PRE <br />M <br />ISES Ea occuren <br />PREMce $100,000 <br /> CLAIMS MADE i] OCCUR MED EXP (Any one person) $ excluded <br /> PERSONAL & ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 <br /> X POLICY IRO- <br />jECT F7 LOC <br />A X AUT OMOBILE LIABILITY 04CA002765974 12/5/2008 12/5/2009 COMBINED SINGLE LIMIT <br /> (Ea accident) $1,000,000 <br /> X ANY AUTO <br /> ALL OWNED AUTOS BODILY INJURY <br />$ <br /> X SCHEDULEDAUTOS (Per person) <br /> HIRED AUTOS <br />BODILY INJURY <br />$ <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTYDAMAGE <br /> $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHERTHAN EAACC $ <br /> AUTOONLY: AGG $ <br />A EXCESS/UMBRELLA LIABILITY 04XS158819 12/5/2008 12/5/2009 EACH OCCURRENCE $1,000,000 <br /> <br /> OCCUR CLAIMS MADE AGGREGATE $1,000,000 <br /> <br /> DEDUCTIBLE $ <br /> X RETENTION $10,000 - - - $ - - <br />B WORKERS COMPENSATION AND SBP0001027321 7/14/2009 7/14/2010 X WRYLMIT OEH <br /> EMPLOYERS' LUIBILITY <br /> <br />ANY PROPRIET <br />R <br />P E.L. EACH ACCIDENT $ 1 Q 0 0 0 0 0 <br /> / <br />ARTNER/EXECUTIVE <br />O <br />OFFICER/MEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1.000,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMEN / <br />Carbon Junction Coal Mine, Durango, <br />Colorado Permit #C-92-080 AUG G 13 2009 <br />DIVI.IUh UT rteclamation, <br />Mining and Safety <br />Colorado Division of Minerals & Geology <br />1313 Sherman Room #215 <br />Denver CO 80203 <br />oCnRn75l9881ro i <br />I.AN%,CLLA I IUIY <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER <br />WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE <br />CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO <br />SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON <br />THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />T10N 1988
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