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2012-12-19_REVISION - C1981025
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2012-12-19_REVISION - C1981025
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Entry Properties
Last modified
8/24/2016 5:11:31 PM
Creation date
12/19/2012 1:38:11 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981025
IBM Index Class Name
REVISION
Doc Date
12/19/2012
Doc Name
Permit Renewal Application
From
J.E. Stover & Associates
To
DRMS
Type & Sequence
RN6
Email Name
BFB
SB1
Media Type
D
Archive
No
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br />f <br />TYPE OF INSURANCE <br />AD�UBR <br />INSR <br />WVD <br />POLICY NUMBER <br />POUCY EFF <br />(MMIDD/YYYY) <br />POLICY EXP <br />(MMUDD/YYYY) <br />LIMITS <br />A <br />GENESLABIUTY <br />X <br />COMMERCIAL GENERAL LABILITY <br />X <br />3X6490413 <br />09/01/2012 <br />09 /01/2013, <br />EACH <br />x1.000,000 <br />q ��OCCURRENCE <br />p REMIS <br />PES (Ea Om ence) <br />$ 100,000 <br />$ 5,000 <br />CLAIMS -MODE X OCCUR <br />MED EXP (My one person) <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />$ 2,000,000 <br />GENI AGGREGATE LIMIT APPLIES PER <br />— 1 POLICY n , n LOC <br />PRODUCTS - COMP /OP AGG <br />$ <br />AUTOMOBILE <br />_ <br />_ <br />UABLTTY <br />ANY AUTO <br />ALL OWNED <br />HIRED AUTOS <br />SCHEDULED <br />NON OWNED <br />AUTOS <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />__s-_ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per aocdent) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />$ <br />UMBRELLA UAB <br />EXCESS UAB <br />_ <br />OCCUR <br />CLAIMS MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DEO I I RETENT ON $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' UABLITY Y/N <br />ANY PROPRIETDR/PARTNER/EXECUTNE <br />OFFICER/MEMBER EXCLUDED' I <br />(Mandatary In NH) <br />If yes deecnbe under <br />DESCRIPTION Cr OPERATIONS below <br />N <br />WC STATU- 0TH - <br />TORY IIMITSI 10TH- <br />E L EACH ACCIDENT <br />$ <br />E L DISEASE - EA EMPLOYEE <br />$ <br />E L DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (Mach ACORD 101, Addlbnel Remarks Schedule, I more space Is required) <br />Re: North Thompson Creek Mines, DRMS Permit C- 1981 -025. State of Colorado, Division of Reclamation Mining <br />& Safety is included as an Additional Insured. 30 days notice of cancellation is provided. <br />Client#: 123725 <br />SBHOLDINI <br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: tithe certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />HUB International Ins Svcs Inc <br />2742 Crossroads Blvd <br />Grand Junction, CO 81506 <br />888 245 -8011 <br />INSURED <br />S & B Holdings LLC <br />Minrec Inc <br />627 241/2 Rd Unit H <br />Grand Junction, CO 81505 <br />DATE (MM/DO/YYYY) <br />9/17/2012 <br />ONTACT NAME. A n i ta Keller <br />N , Ed): 970 - 254 -3306 I ( F r c No 866 908 - 6374 <br />ADDRESS: anita.keller@hubinternational.com <br />INSURER(S) AFFORDING COVERAGE NAIC C <br />INSURER A Employers Mutual Casualty Compa 21415 <br />INSURER B: <br />INSURER C : <br />INSURER D : <br />INSURER E <br />INSURER F CA Resident License #0757776 <br />COVERAGES <br />CERTIFICATE NUMBER: <br />REVISION NUMBER: <br />CERTIFICATE HOLDER <br />CANCELLATION <br />State of Colorado <br />Division of Reclamation Mining & Safety <br />1313 Sherman St, Rm #215 <br />Denver, CO 80203 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />® 1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD <br />#S1827340/M1827328 <br />DCO2 <br />
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