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uwananuu mn nn III II I III III CERTIFICATE OF INSURANCE yyy issued by the COLORADO COMPENSATION INSURANCE AUTHORITY 720 South Colorado Blvd, Denver, Colorado 80222, (303} 782-4000 MAIL TO: CERTIFICATE HOLDER: COLORADO DEPARTMENT OF NATURAL RESOURCES COLORADO DEPARTMENT OF NATURAL RESOURCES MINED LAND RECLAMATION DV MINED LAND RECLAMATION DV 1313 SHERMAN ST. ROOM 215 1313 SHERMAN ST. ROOM 215 DENVER CO 80203-2273 DENVER CO 80203-2273 TO WHOM IT MAY CONCERN: i his is to certity t 1~afttiis company has Issued`a Stan and Workers' Compensation and Employers' Liability Policy as described below covering the liability imposed upon subject employers by the Workers' Compensation Act of Colorado, said policy being in good standing as of this date. POLICY NUMBER: 223489-2 06/01/1994 BROKER OF RECORD: 000011 RIEDMAN CORPORATION/STEAMBOAT POLICY PERIOD: 04/01/1994 TO 04/01/1995 822 LINCOLN AVENUE STEAMBOAT SPRIN CO 80487 INSURED: ROUTT COUNTY LANDSCAPING, (303) 878-1383 INC. P 0 BOX 880099 STEAMBOAT PLZA CO 80488 ORIGINAL EFFECTIVE DATE: 06/23/1990 (" SEE BACK OF CERTIFICATE FOR CLASS COVERAGE AND OWNERSHIP COVERAGE DETAIL. ") IMPORTANT: THE COVERAGE DESCRIBED ABOVE IS IN EFFECT AS OF THE ISSUE DATE OF THIS CERTIFICATE. IT IS SUBJECT TO CHANGE AT ANY TIME IN THE FUTURE. All policies are subject to the following provision of the Workers' Compensation Act with respect to cancellation: Section 8-45-113. If any employer shall be in arrears for more than thirty days in any payment required to be made by him to the Colorado Compensation Insurance Authority as provided by this Act, he shall by virtue of such arrearage be in default of such payment and any policy issued to him by said Authority shall thereupon be cancelled without notice as of the effective date or renewal date of said policy. COLORADO COMPENSATION INSURANCE AUTHORITY costa rxza z.x.u. nuisF ssus nx-ssss UPO~TEO 02/92 P267-O1