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GENERAL38659
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GENERAL38659
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Entry Properties
Last modified
8/24/2016 7:58:21 PM
Creation date
11/23/2007 9:47:22 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981010
IBM Index Class Name
General Documents
Doc Date
8/24/1994
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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TTITC (`FD TT FT!`ATF DFDT A!`FC /1T1F DD FTiT N1CT V CD1ST T\ATFT D /O /O <br /> <br />A/://1.11. CERTIFICATE OF INSURANCE ~II II~IIIII~II~~ III 891'~S"~"~°""' <br /> <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />SEDGWICK JAMES OF TN INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />P 0 BOX 19810 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />KNOXVILLE TN 37939-2810 <br /> COMPANIES AFFORDING COVERAGE <br /> COMAPANY FEDERAL INSURANCE CO. <br />INSURED <br />' <br />CONIBPANV RFl;F~V~~\ <br />IV L <br /> ...t <br />y - <br />.~ <br />1j <br />WILLIAMS FORK COMPANY <br />P O BOX 187 coCANV UG <br />- ~4ti <br /> / <br />~' <br />CRAIG CO 81626 <br /> COMPANY <br /> p ]~ <br />COVERAGES ~ ~' <br />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 - <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSU RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER S, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />CO <br />LTR rypE OF INSURANCE POLICY HUMBER POLICY EFFECTIVE POLICY E%PIRATION LIMRS <br /> DATE (MAVDDIYY) DATE (MMIDDIYY) <br /> GEN ERAL LIABILITY GENERAL AGGREGATE E2 OOO OOO <br />A X COMMERCIALGENERAL LIABILITY (95)37100018 7/20/94 7~20/9S pgODUCTS~COMP/OP AGG E1 OOO OOO <br /> CLAIMS MADE a OCCUR PERSONAL 8 ADV INJURY E 1 OOO OOO <br /> OWNER'SAGONT PROT EACH OCCURRENCE E 1 OOO OOO <br /> FIRE DAMAGE (Any ona lma) S LOO OOO <br /> MED E%P (Any ona person) S lO OOO <br /> AUT OMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT S <br /> ANY AUTO <br /> ALL OWNED AUTOS <br />BODILY INJURV <br />E <br /> SCHEDULED AUTOS (Par person) <br /> HIRED AUTOS <br />BODILY INJURY <br />E <br /> NON-OWNED AUTOS (Per acntlent) <br /> <br /> PROPERTY DAMAGE E <br /> GARAGE LIABILITY AUTOONLY~EA ACCIDENT S <br /> ANY AUTO OTHER THAN AUTO ONLY: <br /> EACH ACCIDENT E <br /> AGGREGATE E <br /> E%CESS LIABILITY EACH OCCURRENCE E <br /> UMBRELLA FORM AGGREGATE E <br /> OTHER THAN UMBRELLA FORM E <br /> WORKERS COMPENSATION AND ~~ _ STATUTORY LIMITS <br /> EMPLOYERS' LIABILITY <br /> EACH ACCIDENT E <br /> THE PROPRIETOR/ <br />PARTNERSIE%EC <br />T <br />VE INCL DISEASE ~ POLICY LIMIT E <br /> U <br />I <br /> OFFICERS ARE. E%CL DISEASE EACH EMPLOYEE E <br /> OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPEGAL ITEMS <br />INSURER WILL NOTIFY DIVISION WHENEVER SUBSTANTIVE CHANGES ARE MADE IN THE POLICY INCLUDING ANY <br />TERMINATION OR FAILURE TO RENEW. THIS POLICY APPLIES TO PERMIT IIC-81-010 AND INCLUDES COVERAGE <br />FOR PROPERTY DAMAGE AND PERSONAL INJURY RESULTING FROM THE USE OF EXPLOSIVES. <br />CERTIFICATE HOLDER CANCELLATION <br />COLORADO DEPT OF NATURAL RESOURCES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />DIVISION OF MINERALS & GEOLOGY EXiI <br />RATION DATE THEREOF, THE ISSUING COMPANY WILL~Q MAIL <br /> O <br />ATTN KEN COBHAM _ DAYS WRITTEN NOTICE TO THE CERTIFlCATE HOLDER NAMED TO THE LEFT, <br />215 CENTENNIAL BUILDING BUT FAILU E TO MAIL SUCH NOTICE SHALL IMPOSE NO OB ON OR LIABILTTY <br />1313 SHERMAN ST OF ANY K THE C PANY, ITS AGENTS R REPRESENTATIVES. <br />DENVER CO SO2O3 UTHO RE ES TIVE <br />I <br />ACORD 25-S (3/93) <br />o ACORD CORPORATION 1993 <br />
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