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GENERAL39125
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GENERAL39125
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Entry Properties
Last modified
8/24/2016 7:58:39 PM
Creation date
11/23/2007 10:00:37 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981038
IBM Index Class Name
General Documents
Doc Date
8/29/2003
Doc Name
Certificate of Liability Insurance
To
DMG
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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Client#: 5934 <br />HORINAT <br />ACORD,N CERTIFICATE OF LIABI LITY INSURANCE ioa°~""' <br />osi <br /> 2 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ACDrdia <br />~®® <br />~ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />~~~~ <br />G <br />TOwBr at Erieview ~++ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />1301 E. Ninth Street #3800 n(1n2 <br />Cleveland, OH 44114-1824 G 29 LI+W ~ " INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />~BN~4~olo8V INSURER A: ZUrICh AmerlCan Ills CO <br />pp¢M~I <br />Bowie Resources, Limi d <br />~r <br />~ <br />rD <br />~ <br />• <br />q <br />'• <br />~µ{ INSURER B: <br />Horizon Natural Re LLC <br />t$ L <br /> INSURER C: <br />2000 Ashland Drlve <br /> INSURER D: <br />Ashland, KY 41101-7058 <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. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER PODCV EFFECTIVE <br />DATE MMIDOrIY POLICY EXPIRATION <br />DATE MMIDD/YY LIMITS <br />A GENERAL LIABIUTV GL0929854903 DtU29~D3 Dti~29~D4 EACH OCCURRENCE $1 DDD DDD <br /> X COMMERCIAL GENERAL LIABILITY PAMMGETORENTED $1DDDDD <br /> CLAIMS MADE O OCCUR MED EXP (Any one person) E1 D DDD <br /> X Blastint] & XCU PERSONALBAOV INJURY E1 DDD DDD <br /> GENERAL AGGREGATE $$ DDD DDD <br /> GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG $2 DDD DDD <br /> POLICY PRP LOC <br />A AUT OMOBILE LIABILITY BAP319030404 Dt1~29~D3 D6~29~D4 <br /> COMBINED SINGLE LIMIT E1 <br />DDD <br />DDD <br /> X ANY AUTO <br />(Ea accitlenl) , <br />, <br /> ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br />BODILY INJURY <br />$ <br /> X NON-0WNED AUTOS (Per accident) <br /> PROPERTY DAMAGE <br /> $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br />A E%CESSNMBRELLA UABILITV EOG929784104 Dti~29~D3 DD~29~D4 EACH OCCURRENCE E2$ DDD DDD <br /> X OCCUR ~ CLAIMS MADE AGGREGATE 82$ DDD DDD <br /> E <br /> DEDUCTIBLE E <br /> X RETENTION $1DDDD $ <br />A WORKERS COMPENSATION AND WC2B5ti44DDti Dti~28~D3 DD@9~D4 )( WC STATU- GTH- <br /> EMPLOVERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />E.L. EACH ACCIDENT <br />$1,DDD,DDD <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYE $1,DDD,DDD <br /> If yes. tlescribe untler <br />SPECIAL PROVISIONS below <br />E.L. DISEASE-POLICY LIMIT <br />$1,DDD,DDD <br /> OTHER <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES / E%CLUSIONS ADDED BV ENDORSEMENT I SPECIAL PROVISIONS <br />Re: Bowie #1 Mine Permit C-81-038 General Liability Policy provides coverage for use of <br />explosives <br />State of Colorado <br />Dept of Natural Resources <br />Div. of Minerals & Geology <br />1313 Sherman Street, Room 215 <br />Denver, CO B0203 <br />DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _,t' D_ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUr FAILURE TO OO SO SHALL <br />IMPOSE NO OBDGATION OR LIABILITY OF ANV KIND UPON THE INSURER ITS AGENTS OR <br />REPRESENTATIVE <br />PI.VKU LD (LVUllU6/ 1 0T2 #54233tlIM41321 YJL t'J NHVrtv MVrtf•vrt/1rrVK rJDD <br />
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