GENERAL39449

• Permit No: C1981023
• IBM Index Class Name: General Documents
• Doc Date: 6/9/2005
• Doc Name: Certificate of Insurance
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER
LOS-000110026-24
PRODUCER THIS CERTIFICATE I8 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Marsh Risk & Insurance Services NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
CA License #0437153 POUCV. THIS CERTIFICATE DOES NOT AMEND, E%TEND OR ALTER THE COVERAGE
777 South Figueroa Street AFFORDED BY THE POLICIES DESCRIBED HEREIN.
Los Angeles, CA 90017 COMPANIES AFFORDING COVERAGE
- ~ Attn: Linda DeFobio: [phone]/ fax: [phone]~
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COMPANY
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54222--IS-05/06 ~ A American International Specialty Lines Insurance Co.
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INSURED ~~~ _--- - -- K~V
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Attn: Paul'Shampay, Vice President, Finan
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lvd., Suite 480
- 3633 E -
COMPANY
Ontario
CA 91764
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COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 4
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTVMTHSTANDING ANV REpUIREMENT, TERM OR CONDITION OF ANV CONTRAC T OR OTHER DOCUMENT MATH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAV
PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS.
'__--__.. __ -___.-
-_-
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~
CO TYPE OFIN$URANCE POLICY NUMBER POLICY EFFECTIVE'POUCY EXPIRATION OMITS
LTRI DATE IMMIDD/YY) ~ DATE{MM/DDMI)
,4 GENERAL LIABILITY 1950494 06/30/01 06/30/13 GENERAL A_GGREGAT_E $ 2,000,000
X COMMERCIAL GENERAL LIABILITY $ 2,000,000
PRODUCTS-COMP/OP AGG
~_; CLAIMS MADE X OCCUR I _
P_ERSONALBA_DV INJU_RV S 1,000,000
OWNER'SBCONTRACTOR'S PROT 'EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE IAny one (rel -_$_ SQ.000
MED E%P A one erson) ~ $ EXCUded
AUTOMOBILE LIABILITY
_, COMBINED SINGLE LIMIT
ANV gUTO
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-_ -_. __-_ - -_-.- - _-_ -_..
L ALL OWNEDAUTOS ~, ~
,
~ BODILY INJURY
~
-
~ SCHEDULED AUTOS ~
'1~ (Per person) ---- ---------- -
I
HIREDAUTOS ~
`
~ BODILY INJURY $
- {Per xcitlenq
NON.OWNED AUTOS ~
- - _ - -_ _- _ - _ _ PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
_ ANV AUTO OTH_E_R_TH_AN AUTO ONLV:_
__ EACH ACCIDENT _$ ___ _
AGGREGATE
A E%CESS LIABILITY 1950494 06/30/01 06/30/13 -EgcH OCCURRENCE $ 10,000,000
X _ UMBRELLA FORM AGGREGATE $ 10.000,000
OTHER THAN UMBRELLA FORM S
WORKER$COMPENSATION AND U- H- -
--EMPt01`ERS'ISA°ILLTY -- -_ _~ORY UpNTS.-___.ER-
__ EL_EACH ACCIDENT S
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT E
PARTNERS/EXECUTIVE ~ --- - --- -- - - - -- - - - --
OFFICERS ARE EXCL EL DISEASE-EACH EMPLOYEE S
THER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIALITEMS
Evidence of Insurance - RE: Chimney Rock Coal (Mine Permit No. C-81 -023)
CERTIFICATE HOLDER CANCELLATION -
SHOULD ANY OF TIE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE E%PIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE IMLL EIY~,d4~6x1Hr MAIL 3Q OATS WRITTEN NOTICE TO THE
.State Of C.OIDradO

Department of Natural Resources CERT6ICATE HOLDER NNdED HEREIN,
Mined Land Reclamation Division ~ >4KXwE
1313 Sherman Street Xx;oD'
xxxxzxxxxxx
D
CO 80203 .
enver, MARSH USA INC.
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Bv: Dan Johnson ~G4+~r..-C~-~o~aH'~
MM7(3/02) VALID AS OF: 06/06/05