1996-07-22_GENERAL DOCUMENTS - C1981017

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CERTIFICATE OF INSURANCE ISSUE DATE 04/25/96 PRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Frost McGahey Insurance, Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, P.O. Box 8410 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 235 South Ridge Street Breckenridge, CO 80424 COMPANIES AFFORDING COVERAGE COMPANY LETTER A: UNION INSURANCE COMPANY } COMPANY LETTER B: �AY 0 1.99t INSURED COMPANY LETTER C: Ray Ward Trucking, Ray Ward and Guyrene Ward dba 30193 Highway 84 COMPANY LETTER D: Dolores, CO 81323 I 01blslh+!ti{ ;""rl� COMPANY LETTER E: J i COVERAGES THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POL. EFF. POL. EXP. LTRI TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS i GENERAL LIABILITY GENERAL AGGREGATE $ 1,000,000 A I [X] COMMERCIAL GENERAL LIABILITY UPK5023812 04/01/96 04/01/97 I PRODUCT-COMP/OPS AGG. $ 1,000,000 [ ] CLAIMS MADE [X] OCCUR. I I PERSONAL & ADV. INJURY $ 1,000,000 I [ ] OWNER'S & CONTRACTOR'S PROT. I I I I EACH OCCURRENCE $ 1,000,000 I [ ] I I I I FIRE DAMAGE (Any one fire) $ 50,000 MED. EXPENSE (Any one person)$ 5,000 i (AUTOMOBILE LIABILITY I [ ] ANY AUTO I I I I COMBINED SINGLE LIMIT $ I [ ] ALL OWNED AUTOS I [ ] SCHEDULED AUTOS I I I I BODILY INJURY (Per person) $ I [ ] HIRED AUTOS I [ ] NON-OWNED AUTOS I I I I BODILY INJURY (Per Accident) $ I [ ] GARAGE LIABILITY I [ ] I I I I PROPERTY DAMAGE $ i (EXCESS LIABILITY I [ ] UMBRELLA FORM I I I I EACH OCCURENCE $ I [ ] OTHER THAN UMBRELLA FORM I I I I AGGREGATE $ i WORKER'S COMPENSATION I I I I I STATUTORY LIMITS I I I I AND I I I I EACH ACCIDENT $ DISEASE-POLICY LIMIT $ EMPLOYER'S LIABILITY I I I I DISEASE-EACH EMPLOYEE $ (OTHER I I I I I $ I I I I I $ I I I I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ADDITIONAL INSURED LISTED AS: DEPARTMENT OF MINERALS AND GEOLOGY CERTIFICATE HOLDER CANCELLATION ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED IBEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY IWILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE ICERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL ISUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ZANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. DIVISION OF MINERALS AND GEOLOGY i (AUTHORIZED REPRESENTATIVE 1313 SHERMAN STREET ROOM 215 I DENVER, CO 80203 FORM 25-S (7/90)