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2012-07-11_GENERAL DOCUMENTS - C1980003
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2012-07-11_GENERAL DOCUMENTS - C1980003
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Entry Properties
Last modified
8/24/2016 5:03:14 PM
Creation date
7/11/2012 10:24:52 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980003
IBM Index Class Name
General Documents
Doc Date
7/11/2012
Doc Name
Certificate of Insurance Notification of Termination
From
DRMS
To
Marsh USA Inc
Permit Index Doc Type
Insurance
Email Name
JRS
DIH
Media Type
D
Archive
No
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ADDITIONAL INFORMATION NYC- 003677526 -19 <br />/MM /DD/YY) <br />06/DA2E <br />29/2010 <br />PRODUCER <br />Marsh USA Inc. <br />1166 Avenue of the Americas <br />New York, NY 10036 -2774 <br />Attn: NewYork.certs @Marsh.com Fax: 212 - 948 -0500 <br />008046- ALL- cas -10 -11 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURER F: <br />W. R. GRACE & CO. <br />7500 GRACE DRIVE <br />INSURER G: <br />COLUMBIA, MD 21044 <br />INSURER H: <br />INSURER I: <br />TEXT <br />Workers Compensation Policies <br />Hartford Accident & Indemnity Insurance Co 10 WN C47906 <br />(CA,CT,KY,MO,MS,WV) <br />Policy 06/30/10 - 06/30/11 <br />Hartford Casualty Ins. Co. 10 WN C47906 <br />(AL,MN,NC,VA) <br />Policy 06/30/10 - 06130/11 <br />Hartford Fire Ins. Co 10 WN C47906 <br />(CO, FL,GA,IA,NE,NV,OH,PR,WA) <br />Policy 06/30/10 - 06/30/11 <br />Hartford Insurance Co of the Midwest 10 WN C47906 <br />(AR,DE,IL,I N, KS, LA, MA, MD, ME ,MI,NH,NJ,NM,NY,SC,SD,TN,TX,UT) <br />Policy 06/30/10 - 06/30/11 <br />Twin City Fire Insurance Company 10 WN C47906 (AZ,OK,PA). <br />Policy 06/30/10 - 06/30/11 <br />CERTIFICATE HOLDER <br />Colorado Division of Minerals and <br />Geology <br />Attn: Jim Stark <br />1313 Sherman Street - Room 215 <br />Denver, CO 80203 <br />E <br />ofMar U ENTAT <br />AInc. NE <br />of Mars USA Inc. <br />Dresa Allman <br />
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