Laserfiche WebLink
ACORD CERTIFICATE OF LIABI OP ID DnrE (MNVporvr) <br />LITY INSURANCE <br /> S <br />8MC0-1 05/19/03 <br />PRODUCER <br />^ ^ <br />-d t THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />~ <br />~~ <br />tV ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Hlaachard Iasuraace Grout' Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />2003 <br />H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Junction CO 81506 MAY 2 ~ <br />Grand <br />Phone: 970-245-8011 Fax: 970-245-8016 INSURERS AFFORDING COVERAGE <br /> <br />INSURED O1V(§(pp pl M(RB:B INSURER A: Employers Mutual Casualty Co. ' <br /> <br /> INSURER B: <br />SEM Construction CO. INSUREA C: <br />715 Horizon Dr1Ve~ $L11t0 219 <br />d J <br />ti <br />CO 81506 INSURER D' <br />uac <br />on <br />Gran <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWRHSTANDING <br />ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO W HICH THIS CERTIFICATE MAV BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CWMS. <br />LTR TYPE OFINSURANCE POLICY NUMBER DATE MMIDD/YY DATE MM/DD/YY LIMITS <br /> GENERAL LIABILfTY EACH OCCURRENCE $1, 000000 <br />A X COMMERCIAL GENERAL LIABILITY 9X90868 05/10/03 OS/1O/O4 FIRE DAMAGE (Any one fire) § 100000 <br /> CLAIMS MADE ^X OCCUR MED EXP (Any one person) S 5, OOO <br /> PERSONAL B ADV INJURY $ S ~ OOO ~ OOO <br /> GENERAL AGGREGATE E2~000~OOO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S2~000~OOO <br /> POLICY PRCaT LOC <br /> AU TOMOBILE LIABILRY <br />COMBINED SINGLE LIMIT <br />51000,000 <br />A X ANY AUTO 9X90668 05/10/03 05/10/04 (Ea accitlenq <br /> ALL OW NED AUTOS <br />BODILY INJURY <br />$ <br /> SCHEDULED AUTOS (Per person) <br /> $ HIRED AUTOS BODILY INJURY <br />$ <br /> ]( NON-OW NED AUTOS (Per atcidenl) <br /> PROPERTY DAMAGE <br /> <br />(Per accident) S <br /> GARAGE LIABNTY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG S <br /> E%CESS LIABILRY EACH OCCURRENCE § <br /> OCCUfl ~ CLAIMS MADE AGGREGATE § <br /> $ <br /> DEDUCTIBLE $ <br /> RETENTION $ S <br /> WORKERS COMPENSATION ANO TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br /> <br />- <br />- ~ ~ ~ ~ <br />~ E.L EACH ACCIDENT § <br /> - - - --_ E. L. DISEASE-EA EMPLOYE $ -- <br /> E.l. DISEASE -POLICY LIMIT E <br /> OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIE%CLUSIONS ADDED BV ENDORSEMENT/SPECIAL PROVISIONS <br />Re: North Thomysoa Creek-File No C-81-025. State Of Colorado, Division Of <br />Minerals & Geology is included as an Additional Iasured.*10 Days Notice due <br />to Non-Paymeat Of Premium.**Or incur substantive changes or failure to <br />renew. <br />CERTIFICATE HOLDER N AODR-ZONAL INSURED; INSURER LETTER: _ CANCELLATION <br />DDD DDOD SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRATION <br />$tat0 Of Colorado DATE THEREOF, TREI§$UING INSURER WILL ENDEAVOR TO MAIL •30 DAYS WRITTEN <br />D1V19 ].On Of Minerals GeOlOgy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BVT FAILURE TO Dp SO SHALL <br />1313 ShermaII Street ROOM 215 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTB OR <br />Denver CO 80203 <br />1988 <br />