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2012-05-11_REVISION - C1981020
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2012-05-11_REVISION - C1981020
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Entry Properties
Last modified
8/24/2016 4:57:33 PM
Creation date
5/14/2012 9:36:19 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981020
IBM Index Class Name
REVISION
Doc Date
5/11/2012
Doc Name
Letter & Application
From
J.E. Stover & Associates, Inc
To
DRMS
Type & Sequence
RN6
Email Name
MPB
SB1
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 />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MM/DD /YYYY) <br />POLICY EXP <br />(MM /DD/YYYY) <br />LIMITS <br />A <br />GENERAL <br />X <br />LIABILITY <br />COMMERCIAL GENERALflABILITY <br />CLAIMS -MADE OCCUR <br />N <br />N <br />GL0936045 <br />12/1/2010 <br />6/1/2012 <br />EACH OCCURRENCE <br />$ 1.000.000 <br />$ 1,000,000 <br />DAMAGE TO RENTE <br />PREM IS Ea occur ante) <br />MED EXP (Any one person) <br />$ 10.000 <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />$ 2,000,000 <br />PRODUCTS - COMP /OP AGG <br />AGGREGATE <br />POLICY <br />LIMIT APPLIES PER. <br />I PEC I X I LOC <br />$ <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED <br />AUTOS <br />HIRED AUTOS <br />_ <br />SCHEDULED <br />AUTOS <br />NON -OWNED <br />AUTOS <br />N <br />N <br />CA0935830 <br />12/1/2010 <br />6/1/2012 <br />COMBINED SINGLE LIMI f <br />(Ea accident) <br />$ 1,000,000 <br />$ XXXXXXX <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />$ XXXXXXX <br />PROPERTY DAMAGE <br />(Per accident) <br />$ XXXXXXX <br />$ XXXXXXX <br />B <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />N <br />N <br />013136615 <br />12/1/2010 <br />6/1/2012 <br />Prjd. <br />EACH OCCURRENCE <br />$ 4,000,000 <br />AGGREGATE <br />$ 4.000,000 <br />DED <br />RETENTION $ <br />Comp /Op <br />$ 4.000 000 <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 below <br />Y / N <br />N / A <br />NOT APPLICABLE <br />WC STATU- <br />( TORY LIMIT <br />OTH- <br />ER <br />E.L. EACH ACCIDENT <br />$ XXXXXXX <br />E L DISEASE - EA EMPLOYEE <br />$ XXXXXXX <br />E L DISEASE - POLICY LIMIT <br />$ XXXXXXX <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />RE. MUNGER CANYON MINE, DRMS PERMIT 1981 -020 <br />ACOR CERTIFICATE OF LIABILITY INSURANCE <br />L---- 6 <br />DATE(MM/DD /YYYY) <br />6/3/2011 <br />I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />:ERTIFICATE 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 LOCktOD Coi11pa111eS,LLC-1 St. Louis <br />Three City Place Drive, Suite 900 <br />St. Lours MO 63141 - 7081 <br />(314) 432-0500 <br />NAME <br />PHONE I AX <br />o Ext)' (A /C, No): <br />E-MAIL <br />ADDRESS' <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A :National Union Fire Ins Co Pittsburgh PA <br />19445 <br />INSURED CAM Mining LLC <br />1340392 265 Hambley Blvd. <br />Pikeville KY 41502 <br />INSURER B : Lexington Insurance Company <br />19437 <br />INSURER C : <br />INSURER D : <br />INSURER E ' <br />INSURER F : <br />COVERAGES <br />CERTIFICATE HOLDER <br />11291473 <br />DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />1313 SHERMAN STREET <br />ROOM 215 <br />DENVER CO 80203 <br />22343CERTIFICATE NUMBER: <br />11291473 <br />CANCELLATION <br />REVISION NUMBER: <br />XXXXXXX <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 />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ©1 ' Win' CORD C ' POR TION. All rights reserved <br />
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