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d-30-199G 2:30PM FROM FROST MCGAHEY INS. 970 4S3 S93S P. 1 <br /> APR.ZS-1996 4:17PM • MAIL BOXES Z314 NO.S?5 P.3 <br /> STATE OF COLORADO <br /> Roy Romer, GovW"W <br /> MPARTAWNT OF NATURAL WOURQES <br /> OIVISM OF MLOLIff <br /> AN MAL oovoRTWiTr UPLOM <br /> ma V. Seam, Mrs~ <br /> ama am&" <br /> DWWW. ootarado 50216 <br /> Teushow. CM 257�11912 <br /> STA'P�iT or Ia180itii!'C8 CLAM <br /> rse aaderaigaad bareby warrants that as of the below dates <br /> 1. No claim have been placed against general Liability Z=nwa=e <br /> Policy #t <br /> Carried by (Zaaurance CGEV W)= <br /> or <br /> Claims hswe been placed against <br /> Canaz%l Liability =asaraaoe polity a: <br /> Date: <br /> Type of Cvverstige <br /> Carried by (Insurance CasQaay)a <br /> a. No c3aj— have been placed against Automobile Liability InsuraACS <br /> policy #: <br /> Carried by (=aa=nnee Compamr)a <br /> or <br /> Claims have been placed against bnta ndAls t d bMty Mm"msaae <br /> volicy : <br /> Date: <br /> Type of CaveZWC s <br /> Carried by (Inenraaea Company): <br /> 3. ?Sere is no knowledge of facts V i.en MY lead to a CIA ill- <br /> or <br /> There iz knowledge of tacca which may lead to a claim against <br /> -'r Policy #1 <br /> Type of Coverage: <br /> Carried by-(Insurance Coag�y) 1 <br /> In the approx. - smc=t of; S <br /> For (type of claim FROST MCGAHEY INSURANCE INC. <br /> 8410 <br /> •B3RECKENRIDGE, CO jQgA <br /> a� Insurance, <br /> Cots P M <br /> BY: <br /> presaAent, owner or Partnez Iyh :Au ze POP `!atative <br /> Attest (SEAL) Pb l D , ✓ 3�" (0 44 i <br /> ome <br /> corporate secretary 3O Q/ „ <br /> m►rs: 1�.� �— 9 HATS= �Y <br />