GENERAL31059

• Permit No: C1981022
• IBM Index Class Name: General Documents
• Doc Date: 9/10/2007
• Doc Name: Certificate of Liability Insurance
• To: DRMS
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

F -~
-- ,,,.,.,~_
4~fih "sv'"~f, ,~'G--~' -
`
'
~
5Y° g- ev 1 .~: ~ DATE(MM~DD~YV~
v
ACORD „ CER~1Fi t;~~ 0=-" AB
~ L A
:..p o9~os~o7
>
r
~
~~~.I~~
;;
iGE
:
_
~ _. a_
~
,,~
.
:
...
:
PxODUCER
AOn Risk SerVl CeS, Inc Of FlOrl da THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
222 Lakeview Avenue AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Suite 510 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
west Palm Beach FL 33401 USA COVERAGE AFFORDED BY THE POLICIES BELOW.
Pxon'e-[phone] FAx-[phone] INSURERS AFFORDING COVERAGE
INSUxeD INSURER A: Hartford Fire insurance co.
oxbow Mining uC INSURER a: Federal Insurance Company
1601 FOrUm P1
West Palm Beach FL 33401-8101 USA .
INSURER C: .
v
w
MSURER D:
G
V
MSURER E:
:e©YERAGE5;"HIis-Cenificatedi nOt intended IDS i alt endorsements,eover e es; lertns,.conditions end exBlusionB ORthe Pcies shown. ~'
- ~
~
TFlE POLICIES OF MSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE MSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITIiSTANDMG 9
ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY 5
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAV HAV E BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF RSURANCE
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LIM1IITS
DATE(MM1i\DD\W) DATEIMM\DD\W) ~
V
B GENERAL LIABILITY 3710776$
l
i
bili 09/01/07 09/01/06 EACH OCCURRENCE $1,000,000 ~

X
COMMERCIAL GENERAL LIABILITY Genera
L
a
ty
- - '-
'~- __
- -
FIRE DAMAGEIAny onef )
$1,000,000 n
rv
CLAIMS MADE X^OCCUR MED EXP (Any une person) $10,000 O

PERSONAL&ADV INJURY
$1,000,000 N
GENERAL AGGREGATE $2,000,000

GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS-COMPiOP AGG
$2
000
000
PRO-
~
~ ~ ,
,
'
POLICY
IECT LOC z
d
W
A A UTOMOBILE LIABILITY 20UENZQ6230 09/01/07 09/01/08 COMBINED SINGLE LIMIT hum..
Business automobile IE=~<cidrnt) $1,000,000 '
L
X ANY AUTO
ALL O WNED AUTOS
DODILY INJURY V
SCHEDULED nUTOE ~ (PR peron)
X HIRED AUTOS BODILY INJllRY
ff(~~Y
'
1 \PU eccWeN)
NON OWNED AUTOS ^
^
~8
~
~~
~
I+ ~1"It(J'1• U PROPERTY DAMAGE
(eu ucdrnp

8 1

: 1
GARAGE LIABILITY Mis>jnp~
OII~M AUTOONLY-EA ACCIDENT
ANY AUTO OTHER THAN EA ACC
AUTO ONLY
AGG
EXCESS LIABILITY EACH OCCURRENCE
OCCUR ~ ClA1M5 MADE AGGREGATE
- ~._. _ __ _ _ ~ _
_ - _DEDUCn~LE- ~~ - _ _ _ _ _ ~ - _ _
_ _
RETENTION
WORKERS COMPENSATION AND
' WC STATU- OTH-
TORY LIMITS ER
EMPLOYERB
LIABILIW EL. EACH ACCIDENT -

E.L. DISEAS~POLICY LIMIT
E.L. DISEASE-EA EMPLOYEE
y~~~J
•
OTHER -

DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Elk creek Mine, Permit Ii1981-022

. .
'
'
.
.. r ~3
A =$OLDER ~." - 3; .::
i:. _
-
GANCELE,ATION~ " ~: '
~
DI VI SI On of Reclamation, Mining SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
and Safety DATE THEREOF, THE ISSUMG COMPANY WILL ENDEAVOR TO h1A1L
1313 Sherman Street, Room 21$ JO DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,
Denver CD 80203 USA BUT FNLURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~ r~
;Ar,.. :< .: ,'F4 .,:., .y fi ......_.. '~ . ~' AGORD- ~OI2FORi1 ~'~~ ~~~ ~