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2009-10-01_GENERAL DOCUMENTS - C1980006
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2009-10-01_GENERAL DOCUMENTS - C1980006
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Last modified
8/24/2016 3:55:54 PM
Creation date
10/2/2009 3:47:51 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980006
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
10/1/2009
Doc Name
Insurance Certificate
Permit Index Doc Type
Insurance
Email Name
JHB
Media Type
D
Archive
No
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ACORD CERTIFICATE OF LIABILITY INSURANCE CSR T5 DATE(MM/DD/YYYY) <br />ENERG-1 09/30/09 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />675 Snapdragon Way Ste 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 772967 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Steamboat Springs CO 80477-2967 <br />Phone: 970-879-1363 Fax: 970-879-0239 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Arch Insurance Company 11150 <br /> <br />E <br />F <br />l INSURER B: <br />nergy <br />ue <br />s Corporation <br />INS <br />R <br />REcz <br />Lindsay Yates U <br />ER C: <br />, <br />PO BOX 773457 <br />Steamboat Springs CO 80477-3457 INSURER D: <br /> INSURER E: 00 0 _0 <br />1 VYCRHl]CJ <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIC??jj??E <br />I <br />6 <br />R <br />NDICFVT:EDILI /ITHSTANDING <br />01 <br />, <br />Ap <br />?t <br />n <br />? <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISI c FCI(LT ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INb <br />LTR INSR <br />TYPE OF INSURANCE <br />POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br />DATE (MM/DD/YY DATE MM/DD/YY <br />LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY CSPKGO0243-01 10/01/09 10/01/10 <br />UAMAU - 'U 111-N <br />P <br />REMISES(Eaoccurence) <br /> <br />$100,000 <br /> CLAIMS MADE [K OCCUR MED EXP (Any one person) $ 5,000 <br />. <br /> <br />P PERSONAL BADVINJURY $1,000,000 <br /> GENERAL AGGREGATE s2, 000 <br />000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG , <br />s2,000,000 <br /> X POLICY PE LOC <br /> AU TOMOBILE LIABILITY <br />COMBINED SINGLE <br /> LIMIT $ <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS BOD <br /> ILY INJURY <br />$ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED,AUTOS <br />BODILY INJURY <br /> $ <br /> ,.NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> $ <br /> i (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> <br />H ANY AUTO EAACC <br />OTHER THAN $ <br /> AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR F? CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE <br /> RETENTION $ $ <br />- WOR KERS NCA Nn <br />OMPE <br />C VVU <br />SIATU- OIH- <br />= _ <br />- <br />. <br />EMPLOYERS' LIABILITY Y <br /> <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> <br />If <br />es <br />describe under E.L. DISEASE - EA EMPLOYEE $ <br /> y <br />, <br />SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> <br />I OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />Reference: Kerr Mine: Permit #C-80-006 <br />and Southfield Mine - Permit #C-81-014. <br />CERTIFICATE HOLDER CANCELLATION <br />CNATURA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br />Colorado Division of Reclamati NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Mining and Safety IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />Division of Minerals & Geology <br />1313 Sherman Street, Rm 215 REPRESENTATIVES. <br />Denver CO 80203 AUTHORIZED REPRESENTATIVE ravv??u <V t<vV ?i VO) U ACORD CORPORATION 1988 <br />
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