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2009-10-05_GENERAL DOCUMENTS - C1981010
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2009-10-05_GENERAL DOCUMENTS - C1981010
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Last modified
8/24/2016 3:55:59 PM
Creation date
10/6/2009 11:21:09 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981010
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
10/5/2009
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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<br />A <br />d CERTIFICATE OF LIABILITY INSURANCE <br />09/29/ M/DDlYYYY) <br />DATE <br />09/29/2009 <br />v <br /> THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br />PRODUCER <br />MARSH USA INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />. <br />SUITE 2100 <br />1225 17TH STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />, <br />DENVER, CO 80202-5534 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Attn: Denver.CertRequest@marsh.com <br />S67982-00125-ALL-09-10 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />9 INSURER A: Great Northern Insurance Company 20303 <br />G <br />?O0 <br />? <br />TRAPPER MINING, INC. <br />PO BOX 187 O?'au0(\, INSURER B: N/A N/A <br />CRAIG, CO 81626 <br />GG\? <br />? INSURER C: <br />a?e <br />Jt <br />Ot 1 <br />t4 %161119 aid INSURER D: <br /> INSURER E: <br />COVERAGES <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 CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br />CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BE EN REDUCED BY PAID CLAIMS. <br />INS <br />LTR ADD' <br />INSR TYPE OF INSURANCE POLICYNUMBER POLICYEFFECTIVE <br />DATE(MM/DD/YYYY) POLICY EXPIRATION <br />DATE(MM/DDIYYYY) LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE 1,000,000 <br /> DAMAGE TO RENTED $ 1 <br />000 <br />000 <br />A X COMMERCIAL GENERAL LIABILITY 37100018 10/01/2009 10/01/2010 PREMISES(Eaoccurrence , <br />1 <br /> CLAIMS MADE O OCCUR MED EXP (Any one person) $ 10,000 <br /> PERSONAL & ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> GENERAL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AG $ 2,000 000 <br /> 1POLICY jE 0 LOC <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br />$ <br /> (Ea accident) <br /> ANY AUTO <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> <br />EDAUTOS (Per person) <br /> SCHEDUL <br /> HIRED AUTOS BODILY INJURY $ <br /> NON-OWNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> (Per accident) $ <br /> <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> OTHER THAN EA ACC $ <br /> ANY AUTO AUTO ONLY: AGG $ <br /> EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE $ <br /> RETENTION $ <br /> WORKER S COMPENSATION AND WC STATU- 0TH- <br /> EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N <br />1. EACH ACCIDENT <br />$ <br /> OFFICER/MEMBER EXCLUDED? FN E.L. DISEASE - EA EMPLOYE $ <br /> (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ <br /> SPECIAL PROVISIONS below <br /> <br /> OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/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. INSURER WILL <br />NOTIFY DIVISION WHENEVER SUBSTANTIVE CHANGES ARE MADE IN THE POLICY INCLUDING ANY TERMINATION OR FAILURE TO RENEW. <br />CFRTIFICATF I-I(N nF:R SFA-001A9AAAA-17 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 59QXPOQ SM MAIL <br />AND SAFETY DEPARTMENT OF NATURAL RESOURCES 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />1313 SHERMAN STREET - ROOM 215 <br />DENVER, CO 80203 <br /> <br />I . <br />XX)w <br /> H IZ U RE <br />AU H aRg EU REPIRESENTATIVE _ -?/?yyLm.?E2? <br />Inc. <br /> Sharon A. Hammer <br />ACORD 25 (2009/01) @ 1998-2009 ACORD CORPORATION. All Klgnts Keservea <br />The ACORD name and logo are registered marks of ACORD
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