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2013-03-18_REVISION - C1981022
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2013-03-18_REVISION - C1981022
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Entry Properties
Last modified
8/24/2016 5:15:12 PM
Creation date
3/18/2013 2:16:10 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981022
IBM Index Class Name
REVISION
Doc Date
3/18/2013
Doc Name
Letter & Application and Public Notice
From
Oxbow Mining, LLC
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. Limits shown are as requested <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MMIDDIYYYY <br />POLICY EXP <br />(MDDrrrro <br />MI 6/0 <br />LIMITS <br />B <br />GENERAL <br />X <br />— <br />LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X OCCUR <br />16535 <br />INSURERS. American Zurich Ins co <br />GL0926594902 <br />General Li abl i ty <br />SIR applies per policy terns <br />06/01/20 <br />& condi -ions <br />01/23 <br />0 1 <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) <br />$1,000,000 <br />MED EXP (Any one person) <br />$10,000 <br />PERSONAL & ADV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$5,000,000 <br />PRODUCTS - COMP /OP AGG <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />7 POLICY Il .IFCOT n LOC <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED <br />AUTOS <br />HIRED AUTOS <br />— <br />_ <br />_ <br />SCHEDULED <br />AUTOS <br />NON -OWNED <br />AUTOS <br />BAP 9265950 - 02 <br />Business Automobile Cover <br />06/01/2012 <br />06/01/2013 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$1,000,000 <br />BODILY INJURY ( Per person) <br />BODILY INJURY (Per acadent) <br />PROPERTY DAMAGE <br />(Per accident) <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />AGGREGATE <br />DED (RETENTION <br />WORKERS COMPENSAT ON AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR / PARTNER / EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, descnbe under <br />DESCRIPTION OF OPERATIONS below <br />Y / N <br />N / A <br />WC STATU- <br />TORY LIMITS <br />OTH- <br />ER <br />E L EACH ACCIDENT <br />E L DISEASE -EA EMPLOYEE <br />E L DISEASE - POLICY LIMIT <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is equired) <br />RE: Elk creek Mine Permit #1981 - 022 <br />.--- ® <br />.°` CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYY) <br />06/12/2012 <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: If the 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 />Aon Ri sk Services, Inc of Florida <br />222 Lakeview Avenue <br />Suite 510 <br />West Palm Beach FL 33401 USA <br />CONTACT <br />NAME: <br />(NCNNo.Ext): (8 66) 283 - 7122 FAX No.)- (847) 953 - 5390 <br />E <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIL # <br />INSURED <br />Oxbow mining, LLC <br />1601 Forum Place <br />Suite 1400 <br />West Palm Beach FL 33401 -8101 USA <br />INSURERA Zurich American Ins Co <br />16535 <br />INSURERS. American Zurich Ins co <br />40142 <br />INSURER C. <br />INSURER D. <br />INSURER E: <br />INSURER F: <br />COVERAGES <br />CERTIFICATE HOLDER <br />ACORD 25 (2010/05) <br />CERTIFICATE NUMBER: 570046528857 <br />CANCELLATION <br />REVISION NUMBER: <br />©1988 -2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />• <br />2 <br />r- <br />1 <br />Division of Reclamation <br />Mining and safety <br />1313 Sherman street <br />Room 215 <br />Denver CO 80203 USA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />_ 2,:vc cJ v3riaz <br />
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