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I HULK MUKANUt tAUMANut <br /> A�w&W �I <br /> INTERIM CERTIFICATE AS TO EVIDENCE OF INSURANCE I <br /> THIS IS NOT AN INSURANCE POLICY THIS IS ONLY A VERIFICATION OF INSURANCE IT DOES NOT IN ANY WAY AMEND, EXTEND OR ALTER THE <br /> COVERAGE PROVIDED BY THE POLICIES LISTED BELOW <br /> Named GARY E. RINDERLE <br /> Insured . GARY RINDS RLE CONSTRUCTION. 4584 72 50 <br /> Address . 542 33 RD. Policy#-Gen Liab. <br /> • CLIFTON., CO. 81520 07 50 353 <br /> Agent Policy#-Auto Liab <br /> Policy#-CARGO <br /> This is to certify that policies for the above named insured are in force as follows: <br /> Policy#-Work Comp <br /> This Interim Certificate As To Evidence of Insurance shall expire sixty days from 4:30 P. M <br /> JULY 14, 1995 , 19 _ unless cancelled prior to such date by written notice to the named insured. <br /> FLIA Please issue a Permanent Certificate <br /> COVERAGE COMBINED LIMITS OF LIABILITY <br /> COVERED NOT AUTO <br /> COVERED LIABILITY <br /> ® Owned Bodily Injury $ 000 each person <br /> ® Hired $ 000 each occurrence <br /> ® Non-Owned Property Damage $ 000 each occurrence <br /> ® Employer's Non-Ownership <br /> Contingent Liability <br /> Single Limit Liability for Coverages checked ®above $ 1 ir 000 r 000 each occurrence <br /> GENERAL LIABILITY Bodily Injury $ 000 each person <br /> M&C - OLT <br /> Owners & Contractors $ 000 each occurrence <br /> ® ❑ Contractual* $ 000 annual aggregate <br /> products *** <br /> Elevators❑ Products and/or Property Damage $ 000 each occurrence <br /> $ 000 annual aggro ate <br /> Completed Operations products *r* <br /> Single Limit Liability for Coverages checked ®above $ 1 000 <br /> � 000 each occurrence <br /> $ 1 ,000 000 annual aggregate <br /> products ** * <br /> ❑ © CARGO $ 000 each vehicle <br /> $ 000 each occurrence <br /> ❑ © COMPENSATION Statutory <br /> * Includes Goods or Products Warranty, Written Lease of Premises, Easement Agreement, Municipal Ordinance <br /> Agreement, Sidetrack Agreement, Elevator or Escalator Maintenance Agreement only, unless accompanied by <br /> specific endorsement providing additional Contractual Coverage. <br /> ❑ Downbed El13 unpbon <br /> below waived <br /> OWNED YEAR,MAKE,TYPE OF BODY,LOAD CAPACITY IDENTIFICATION NUMBER <br /> AUTO- <br /> MOBILES, LAST 3 <br /> IF <br /> DIGITS <br /> COVERED SHOWN <br /> Umbrella Liability $ 000 retained limit <br /> POLICY NUMBER <br /> $ each occurrence <br /> $ aggregate <br /> If the Interim Certificate As To Evidence Of Insurance is to be cancelled prior to the expiration date, we shall <br /> provide 10(TEN) days advance notice in writing to whom this certificate is issued. <br /> ATT'N:MAGIE VANCLEEF <br /> Certificate issued to: ADDITIONAL INSURED <br /> Name <br /> STATE OF COLORADO Numbe Loan <br /> r <br /> And ' <br /> Address DIVISION OF MINERAL & GEOLOGY <br /> 1313 SIUUZMAN ST. RM 215 1� <br /> � DENVER, CO. £30203 <br /> Countersigned _I <br /> va Authorized Representative <br /> * * Not Applicable in Texas. <br /> * * * In Texas the aggregate also applies to owners and contractors protective,contractual and/or completed operations. <br /> 56-0514 2-90 1651 W/200 C/1200 1-91 11551 <br />