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e <br /> CERTIFICATE OF INSURANCE <br /> issued by the <br /> COLORADO COMPENSATION INSURANCE AUTHORITY <br /> 950 SROADWAY, DENVER, COLORADO 80203, (303) 837-4000 COLORADO <br /> COMPENSATION <br /> INSURANCE <br /> TO WHOM IT MAY CONCERN: <br /> This is to certify that this company has issued a Standard Workmen's Compensation and Employer's <br /> Liability Policy as described below covering the liability Imposed upon subject employers by the <br /> Workmen's Compensation Act of Colorado, said policy being in good standing as of this date. <br /> POLICY NUMBER: 149794-2 JUNE 27, 1991 <br /> POLICY PERIOD: JULY 1, 1991 TO JULY 1, 1992 <br /> INSURED: WESTERN STATES RECLAMAATION INC. <br /> 11730 WADSWORTH BLVD. <br /> BROOMFIELD( CO 80020 <br /> DATE OF ORIGINAL ISSUE: JUNE 28, 1983 <br /> QUARTERLY ADJUSTMENT <br /> ** FOR ADDITIONAL COPIES, THIS CERTIFICATE MAY BE REPRODUCED. ** <br /> IMPORTANT: THE COVERAGE DESCRIBED ABOVE IS IN EFFECT AS OF THE ISSUE DATE <br /> OF THIS CERTIFICATE. IT IS SUBJECT TO CHANGE AT ANY TIME IN THE FUTURE. <br /> Ail policies are subject to the following provision of the Workmen's Compensation Act with <br /> respect to cancellation: <br /> Section 8-54-114. If any employer shall be In arrears for more than thirty days In any payment required to <br /> be made by him to the Colorado Compensation Insurance Authority as provided by this Act, he shall by <br /> virtue of such arrangement be In default of such payment and any policy Issued to him by said Authority <br /> shall thereupon be cancelled without notice as of the effective date or renewal date of said policy. <br /> Cz <br /> COMPENSATION INS RANCE AUTHORITY <br /> FARM P�-287(8-88) I�LL:bam LUCERO, INSURANCE REPRESENTATIVE <br />