Laserfiche WebLink
02/13/2009 01:06PM Pinnacol Assurance PAGE 3 OF 3 <br />CERTIFICATE HOLDER COPY <br />division of reclamation mining and safet <br />1313 Sherman street #215 <br />denver CO 80203 <br />IMPORTANT <br />If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A <br />statement on this certificate does not confer rights to the certificate holder in lieu of such <br />endorsement(s). <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain <br />policies may require an endorsement. A statement on this certificate does not confer rights <br />to the certificate holder in lieu of such endorsement(s). <br />DISCLAIMER <br />The Certificate of Insurance on the reverse side of this form does not constitute a contract <br />between the issuing insurer(s), authorized representative or producer, and the certificate <br />holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded <br />by the policies listed thereon.