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2010-09-08_GENERAL DOCUMENTS - C1981025
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2010-09-08_GENERAL DOCUMENTS - C1981025
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Last modified
8/24/2016 4:21:45 PM
Creation date
9/9/2010 8:44:14 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981025
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
9/8/2010
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JRS
SB1
Media Type
D
Archive
No
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QE2Uf%1 n1K14 <br />i i - Ir11WIlliff. ILJI LJ -••----'-- <br />ACORD,M CERTIFICATE OF LIABILITY INSURANCE <br />7 <br /> <br /> <br />/01/201DATE <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />HUB International Ins Svcs Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />2742 Crossroads Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Grand Junction, CO 81506 Q <br />970 245-8011 <br />9 INSURERS AFFORDING COVERAGE NAIC # <br />0 <br />INSURED qW, <br />O INSURER A: EMC Insurance Companies 999999 <br />\ <br />Minrec Inc INSURER B: <br />it H <br />27 24112 Rd U <br />Q Q <br />a <br />n <br />6 <br />O? <br />` INSURER C: <br />Grand Junction, CO 8150 ON ? <br />off 9t1a <br />INSURER D: <br />, <br />??rg <br />Q? INSURER E: <br />? <br />GVVGFCAVC.J <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />ANY REQUIREMENT <br />, <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />PERTAIN <br />, <br />MAY <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> <br />I <br />DD' POLICY EFFECTIVE POLICY EXPIRATION <br />LIMITS <br />LTR N <br />NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YYYY DATE MMIDDIYYYY <br /> GENERAL LIABILITY 3X6490411 09/01/2010 09101/2011 EACH OCCURRENCE $1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br />MISES (Ea occurrence) $100,000 <br /> CLAIMS MADE a OCCUR MED EXP (Any one person) s5,000 <br /> PERSONAL & ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE s2,000,000 <br /> 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 000 000 <br /> F <br /> PRO LOC <br />POLICY <br />JECT <br />A AUTOMOBILE LIABILITY 3X6490411 09101/2010 09/01/2011 COMBINED SINGLE LIMIT $1 <br />000 <br />000 <br /> X ANY AUTO (Ea accident) , <br />, <br /> <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> <br /> X HIRED AUTOS BODILY INJURY $ <br /> X OWNED AUTOS <br />NON (Per accident) <br /> - <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> GA <br /> TO OTHER THAN EA ACC $ <br /> ANY AU AUTO ONLY: AGG $ <br /> EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> 1 OCCUR EICLAIMS MADE AGGREGATE $ <br /> <br /> <br /> DEDUCTIBLE $ <br /> R <br /> RETENTION $ $ <br /> WC STATU- OTH- <br /> WORKERS COMPENSATION AND ER <br /> <br />EMPLOYERS' LIABILITY <br />PRIETOR/PARTNER/EXECUTIVE <br />R . <br /> <br />E.L. EACH ACCIDENT <br /> <br />$ <br /> ANY P <br />O <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br /> <br /> If yes, describe under <br />L. DISEASE - POLICY LIMIT <br />E <br />$ <br /> SPECIAL PROVISIONS below . <br /> <br /> OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />Re: North Thompson Creek Mines, DRMS Permit C-1981-025. State of <br />Colorado, Division of Reclamation Mining & Safety is included as an <br />Additional Insured per attached CG2013(5-09). <br />CERTIFICATE HOLDER 1rA1\VGLL/111Vn ?....-. <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />State of Colorado DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN <br />Division of Reclamation Mining & Safety NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />1313 Sherman St, Rim #215 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />Denver, CO 80203 REPRESENTATIVES. <br />AUTHORIZED REPR SENTATIVE <br />Qo_. "g,, . . M C,;r 4 <br />ACORD 25 (2009/01) 1 Of 2 #S830902/M830893 U 1`J88-LVU7 AIiVRL/ 6 VRrVRM11V1?. I\II nyaa •. ... <br />The ACORD name and logo are registered marks of ACORD AK01
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