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GENERAL43494
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GENERAL43494
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Entry Properties
Last modified
8/24/2016 8:12:14 PM
Creation date
11/23/2007 12:25:28 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981029
IBM Index Class Name
General Documents
Doc Date
6/5/1986
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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<br />_.. <br />n o ~ n s a <br />0 0 0 0~ U ~ C <br />C,~000~® C~'9~t~1~CIC~lIJ~, CLr [u ti~C71_~/ y ti~_ III fl1D01~01~Q~Q~ O1Q , SSUE DATE IMM,~oIn <br />-- -- -- _ - sss 16/2/86 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A C7ATTER OF I\FOAC.7ATION ONLY AND CONFERS <br />NO RIGHTS UPON THE CERTIFCATE HOLDER. THIS CERTIFlCATE DOES NOT Af7END, <br />El(TENO OA ALTER THE COVERAGE AFFORDED Br THE POLICES BELOW. <br />Flat Top Insurance Agency ~®M~b1R10E~ Edgy=~®."•d~~R11'a CObGRA2s <br />P. 0. Box 1439 <br />Bluefield, WV 24701 COMPMIY Q <br />M1 1,- ~.~,,~, LETTERj Old Republic Insurance Company <br />~" ~.T ~~?..~-~ LETTERHV Q <br />INSURED ~ r <br />'''' S ~ ^ ERNV ~ 1 .AT i.,P i .~ <br />Sun Coal Company '~U~Y Q ~ - •^~ <br />5440 Ward Rd ~ "" <br />Ste 210-7 i~rMTeANr [U , `~ ' <br />Arvada, CO 80002 n;y, ~ ~ - rr~~+ <br />l'•(l~~ f_I,.~±'. ., -• ~ ~FTMTERNr LS .nw.nn.w=.n.aov.W <br />INDICATED. I <br />FICATE CSAY <br />AND CONDI- <br />CO <br />TYPE OF INSURANCE <br />POLICY NUMBER PpLICV fFFfCTNE PDLN.'I EXA'R4 RGY LIABILITY LIMITS IN THOUSANDS <br />LTR WiE IMMIDD~"YI DATE (N.MllNYYI EACH <br />OCCURRENCE AGGREGATE <br /> GE NERAL LIABILITY BODILY <br />A X COMPREHENSNEFORM ZC46493 12/06/85 03/01/87 IwuRV $ 1,000 $ 1,000, <br /> X PREMISES/OPERATIONS PROPERTr <br /> X NU DAMAGE $ 1 , OOO $ 1 , OOO , <br /> E%PLOSIO <br />B COLLAPSE HAZARD <br /> X PRODIICTS/COMPLETED OPERATIONS <br /> CONTRACTUAL el a PD <br />$ <br />$ <br /> COMBINED ` <br /> <br />X <br />INDEPENDENT CONTPACiOR$ I <br />I <br /> X BROAD FORM PROPERTY DAMAGE <br /> X PERSONAL INJURY PERSONAL IWURV $ <br /> A UT0:.:081LE LIABILITY B7Ar <br /> ANV AUTO ~ Pfl6C:A $ <br /> ALL OWNED AUTOS (PENN. PASS.) &'DLy <br /> ALL OWNED AUTOS (OTHER THAN1 <br />PAN. PASS. / y~ <br />~N ~~ <br />$ <br /> HIRED AlJT05 <br /> PROPERTY <br /> NON-0WNED AUf05 DAMAGE $ <br /> GARAGE LIABLffV <br /> BI 6 PD <br /> COMBINED $ <br /> E%cESS uaelurr <br /> UMBRELLA FORM BI a PD <br />$ <br />$ <br /> COMBINED <br /> OTHER THAN UMBRELLA FORM <br /> WORKERS' C0:7PENSATION STATUTORY <br /> AND $ (EACH ACCIOENTI <br /> E:7PLOYERS' LIABILITY $ (DISEASEPOLICY LIMIT) <br /> $ (DISEASE-EACH EMPLOYEE) <br /> OTHER <br />A Environmental <br /> Impairment ZP0241 12/06/85 03/01/87 $1,000,000 <br />utx.nm nun ur VrennIIUNJILUGMIIUNS/VtMIGLE5l5YEGIAI REMS <br />l~a~nmaTyal2 ~u~Ja~l <br />Colorado Mined Land Reclamation Division <br />423 Centennial Bldg <br />1313 Sherman St <br />Denver, CO 80203 <br />Y,.c=a psi ~4~, ~r[D]. ~ <br />SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%- <br />PIRATION DATE THEREOF, THE ISSUING COCiPANY WILL ENDEAVOR TO <br />L7AIL 1 Q DAYS FJRITTEN NOTICE 70 THE CERTIFICATE HOLDER NAMED 70 THE <br />LEFT, BUT FAILURE TO C7AIL SUCH NOTK~ SHALL L`.-POSE NO OBLIGATION OA UABILTIY <br />~; <br />'a <br />1' <br />I' <br />~~ <br />dl <br />f I' <br />it <br />i <br />I <br />i <br />III III <br /> <br />
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