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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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THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br />CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />NSRADD1 <br />LTR <br />INSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICYEFFECTIVE <br />DATE(MM/DD/YYYY) <br />POLICY EXPIRATION <br />DATE(MM/DD/YYYY) <br />LIMITS <br />INSURER, ITS AGENTS OR REPRESENTATIVES. <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />SELF INSURED <br />06/30/2010 <br />06/30/2011 <br />EACH OCCURRENCE <br />5,000,000 <br />DAMAGE RENTED <br />PREMISES( Ea occurrence ) <br />$ 5,000,000 <br />MED EXP (Any one person) <br />$ EXCLUDED <br />CLAIMS MACE OCCUR <br />PERSONAL BADV INJURY <br />$ 5,000,000 <br />X S ELF- INSURED <br />W. R. GRACE & CO <br />GENERAL AGGREGATE <br />$ <br />GENERAL AGGREGATE LIMIT APPLIES PER <br />- <br />POLICY JEC T LOC <br />PRODUCTS - COMP /OP AG <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />10 CSE C47908 <br />06/30/2010 <br />06/30/2011 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 2,000,000 <br />ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br />SCHEDULED AUTOS <br />(Per person) <br />BODILY INJURY <br />$ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />GARAGE <br />LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />ANY AUTO <br />OTHER THAN EA ACC <br />$ <br />$ <br />AUTO ONLY: <br />AGG <br />EXCESS / UMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$ <br />OCCUR F� CLAIMS MADE <br />AGGREGATE <br />$ <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />X WC STATU- I OTH- <br />2YjJjMff FR <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />SEE ADDITIONAL PAGE <br />- .L. EACH ACCIDENT <br />$ 2,000,000 <br />.L. DISEASE - EA EMPLOYE <br />$ 2 <br />OFFICER/MEMBER EXCLUDED? FN <br />L. DISEASE - POLICY LIMIT <br />2,000,000 <br />(Mandatory in NH) If yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER - -- - <br />DESCRIPTION OF OPERATIONS /LOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />The coverage and limits stated above apply to Permit #C80 -003 <br />CERTIFICATE HOLDER NYC - 003677526 -19 CANCELLATION <br />ACORD 25 (2009/01) © 1998 -2009 ACORD CORPORATION. All Rights Reserved <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />Colorado Division of Minerals and <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />Geology <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Attn: Jim Stark <br />1313 Sherman Street - Room 215 <br />BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND <br />Denver CO 80203 <br />INSURER, ITS AGENTS OR REPRESENTATIVES. <br />} pp((��EE <br />r; M eB BRWI ESENTATIVE / / . , , e /� /j � � <br />esa Allman <br />ACORD 25 (2009/01) © 1998 -2009 ACORD CORPORATION. All Rights Reserved <br />The ACORD name and logo are registered marks of ACORD <br />
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