2010-06-01_GENERAL DOCUMENTS - C1981019

• Permit No: C1981019
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 6/1/2010
• Doc Name: Certificate of Insurance
• From: Wells Fargo Insurance
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: JRS
• Email Name: SB1
• Media Type: D
• Archive: No

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w-e.-t IS
CERTIFICATE OF INSURANCE
I68U27/10
5//27/10
ACORD?
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
PRODUCER: CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE
Inc.
o Insurance Services USA
Wells Far DOES NOT AMEND, EXTEND OR ALTER OTHER COVERAGE AFFORDED BY THE
,
g POLICIES BELOW.
45 Fremont Street, Suite 800 I
'o COMPANIES AFFORDING COVERAGE
"
San Francisco CA 94105 ??4 COMPANY Zurich American Insurance Company
CA DOI License #0008408 ,? '\% 4?p COMPANY Insurance Company of the State of PA
phone: [phone] fax: 411.71 3\ '0 " LETTER B
INSURED: COMPANY
LETTER C Insurance Company of the State of PA
4'A
Colowyo Coal Company, L.P. y E • COMPANY
LETTER D
5731 State Highway 13 COMPANY
LETTER E
Meeker CO 81641
"' COVERAGES AND LIMITS
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER
CO
POLICY EFF. POLICY EXP. DESCRIPTION LIMITS
.
LTR DATE DATE
A GENERAL LIABILITY GL08249662-01 5/31/2010 5/31/2011 GENERAL AGGREGATE $ 2,000,000
X COMM. GENERAL LIAB. PROD-COMP/OP AGG. $ 2,000,000
CLAIMS MADE PERS & ADV. INJURY $ 2,000,000
? OCCURRENCE EACH OCCURRENCE $ 2,000,000
OWNER'S & CONTRACTS PROT FIRE DAMAGE (One Fire) $ 100,000
? MEDICAL EXPENSE (One Per) $ 5,000
B AUTOMOBILE LIABILITY CA7204495 5/31/2010 5/31/2011
? ANY AUTO
X COMBINED SINGLE LIMIT $ 1,000,000
ALL OWNED AUTOS BODILY INJURY (Per Person)
SCHEDULED AUTOS BODILY INJURY (Per Accident)
Q HIRED AUTOS PROPERTY DAMAGE
El NON-OWNED AUTOS
GARAGE LIABILITY
E
XCESS LIABILrTY EACH OCCURRENCE
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
C WORKERS'COMPENSATIONAND WC7208192 5/31/2010 5/31/2011 x? STATUTORY LIMITS
EMPLOYER'S LIABILITY EACH ACCIDENT $ 1,000,000
DISEASE - POLICY LIMIT $ 1,000,000
DISEASE - EACH EMPLOYEE $ 1,000,000
OTHER INSURANCE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS:
Re: Mining Permit C-81-019, See Attached Addendum.
NAME AND ADDRESS OF CERTIFICATE HOLDER: 110 CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS WRITTEN NOTICE TO THE
Colorado Division of Reclamation Mining and Safety CERTIFICATE HOLDER NAMED TO THE LEFT.
attn: James Stark
1313 Sherman Street, 215 Centennial Building AUTHORIZED REP ENTATIVE:

Denver CO 80203
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