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2011-10-04_GENERAL DOCUMENTS - C1980006
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2011-10-04_GENERAL DOCUMENTS - C1980006
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Last modified
8/24/2016 4:43:45 PM
Creation date
10/4/2011 12:45:12 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980006
IBM Index Class Name
General Documents
Doc Date
10/4/2011
Doc Name
Certificate of Liability Insurance
From
Chevron Mining, Inc
To
DRMS
Permit Index Doc Type
Insurance
Email Name
RDZ
Media Type
D
Archive
No
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />A <br />INSR <br />WVD <br />CONTACT <br />NAME: <br />POLICY NUMBER <br />POLICY EFF <br />(MM /DD/YYYY) <br />POLICY EXP <br />(MM /DD/YYYY) <br />LIMITS <br />NAIL # <br />A <br />GENERAL <br />LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />OCCUR <br />INSURERS <br />GL00011080 <br />10/01/11 <br />10/01/12 <br />EACH OCCURRENCE <br />$ <br />1,000,000 <br />X <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) <br />$ <br />100 000 <br />CLAIMS -MADE <br />MED EXP (Any one person) <br />$ <br />5,000 <br />PERSONAL & ADV INJURY <br />$ <br />1,000,000 <br />GENERAL AGGREGATE <br />$ <br />2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP /OP AGG <br />$ <br />2,000,000 <br />X. <br />POLICY PRO- LOC <br />.IFCT <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS • <br />NON -OWNED AUTOS <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />-- -- <br />— -- -- - -- <br />- <br />–_ <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />RETENTION $ — – <br />$ <br />_— _._•_. <br />_$_ <br />— <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR /PARTNER/EXECUTIVE <br />OFFICER /MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS <br />�, / N <br />N / A <br />WC CY STATU- <br />ITS I 1 <br />ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) <br />Reference: Kerr Mine: Permit #C -80 -006 <br />and Southfield Mine - Permit #C -81 -014. <br />OR °K CERTIFICATE OF LIABILITY INSURANCE <br />A� 09//299 <br />DATE 2 <br />/11 /11 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER. -. 970 -879 -1363 <br />Brown & Brown Insurance 970- 879 -0239 <br />675.Snapdragon Way; Suite 200 <br />Steamboat Springs, CO 80487 <br />Todd A. Hayes IV'E <br />CONTACT <br />NAME: <br />PHONE FAX <br />INC. o, Ext): (NC, No): <br />E-MAIL <br />ADDRESS: <br />PRODUCER ENERG -1 <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE <br />NAIL # <br />INSURED Energy Fuels Corporation <br />Lindsay Yates ° CI 0 4 Z Q1 \ <br />PO Box 773457 u41 <br />Steamboat Springs, CO 80477-3 7 °I leciamat+on, <br />minin9 a nd Safety <br />INSURERA: Midwest Insurance Co <br />18694 <br />INSURER B : <br />INSURERS <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />COVERAGES. <br />CERTIFICATE HOLDER <br />ACORD 25 (2009/09) <br />CERTIFICATE NUMBER: <br />CANCELLATION <br />REVISION NUMBER: <br />OP ID: T5 <br />Colorado Division of Reclamati <br />Mining and Safety <br />Division of Minerals & Geology <br />1313 Sherman Street, Rm 215 <br />(Denver, CO 80203 <br />CNATURA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />r . <br />© 1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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