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GENERAL44202
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Entry Properties
Last modified
8/24/2016 8:13:00 PM
Creation date
11/23/2007 12:54:09 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981011
IBM Index Class Name
General Documents
Doc Date
9/11/1995
Doc Name
CERTIFICATE OF INSURANCE
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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acoan CERTIFICATE OF INSURANCE III IIIIIIIIIIiII III °"'~""'°""" <br />ggg 9/05/95 <br />PROOUCff ~ ~~C/ THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION <br />/ ONLY AND CONFERS MO RIGHTS UPOM THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />S e d g w i c k dames o f T N, I n c . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELON. <br />P. 0. Box 1 9 8 1 0 R COMPANIES AFFORDING COVERAGE <br />~ <br />Knoxville, TN 37939-2810 <br />EIVEp COMPANY <br />A National Union Fire Ins. Co. <br />INSUFrFD 5 COMPANY <br /> g Lexington lns. Co. <br />Divisio <br />n o1 Mlnerais t~ Geolo <br />contain coat , l n ~ COMPANY <br />gy <br />249 East Main St. Suite 400 C <br /> <br />Lexington KY 40507 _ <br />COMPANY <br /> D <br />COVERAGES <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOYI HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER100 <br />INDICATED, NOTUI THSTANOI NG ANY REQUIREMENT, TERM OR CONDITION OF qNY CONTRACT OR OTHER DOCUMENT V71TH RESPECT TO IJHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SH041N MAY HAVE BEEN REDUCED BY PgID CLAIMS. <br />~ TYPE OF QLSUFiANCE POLICY NUMBEA POLICY E>-PEGRIVE POLICY FE)<PIMTION BLS <br />LlN DATEINN/DO/YY) pATE(MSNODM') <br />A cEN ETTnL /uennY G L 5 4 1 1 5 6 8 R A 9/ 0 1/ 9 5 5/ 0 1/ 9 6 u'ENEPAL AGGREGATE s 2 0 0 0 0 0 0 <br /> X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPAGG S I_N_C_L <br /> MADES ~ OCCUR PERSONALBADV INJURY a L0.0.0.011A <br /> OWNER'S SCONT PROT EACH OCCURRENCE S 1 B B B D B B <br /> FIRE DAMAGE (Any one fre) y <br /> MED EXP (Any one parson) y 5 D D D <br />A ^~ O/AO~~I-~Y CA5411569RA 9/01/95 9/01/96 <br /> X ANY AUTO COMBINED SINGLE LIMIT S I O O O O O O <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS IPer person) $ <br /> HIRED AUTOS <br />BODILY INJURY <br /> <br />NON-OWNED AUTO <br />IPer a¢Idnell f <br /> 3 <br /> PROPERTY DAMAGE <br /> GARAGE OAI3RJTY AUTO ONLY ~ EA ACCIDENT 3 <br /> ANY AlRO OTHER THAN AUTO ONLY: 5 <br /> EACH ACCIDENT y <br /> AGGREGATE E <br />B Excess Lw®un 5 1 0 6 5 8 7 9/ 0 1/ 9 5 9/ 0 1/ 9 6 x 1 0 <br />0 0 0 <br />0 0 0 <br /> EacH occuRRENCE , <br />, <br /> UMBRELLA FORM AGGREGATE E l 0, 0 0 0, O O O <br /> OTHER THAN UMBRELLA FORM <br /> WOfYQ1ANS COMPENSATION AND <br /> EIAPIDYERS LNBRPY STATIJFORV LIMITS $ <br /> <br /> EACH ACCIDENT 5 <br /> THE PROPRIETOFV <br /> <br />PARTNERS/E%ECUTIVE INCL DISEASE ~ POLICY LIMIT <br />S <br /> OFFICERS ARE: E%CL DISEASE-EACH EMPLOYEE 5 <br /> QR~A <br />DESCTaPT10N aF OPEJi4T1ON$LOG110NS/VpOCIE$ISPECVLL fIFMS <br />CERTIFICATE HOLDER CANCELLATION <br /> SHOLAD ANY aF THE ABOVE OESClYBED F0.1L1E5 BE f2NT Fn BETTX€ THE <br />COLORADO DEPARTMENT O F M 1 N E 5 & MINER L S °~0~~ °A~ TMQgOF' THE LZSUwG CONPANV xnu ENDEAVOR TO NAIL <br />1 3 1 3 S H E R M A N S T. R O O M 2 1 5 3 0 DAYS xaarTEN NorlcE To THE ~{nFIGTE HoLT>Ep NM~p To THE Iffy <br />DENVER , C 0 8 0 2 0 3 BUF FNLUF€ TO NAIL SUCH NOTICE SHALL WPOSE NO OBl1GlOpN On UABIl1TY <br /> OF ANY qND 1HE COMPANY, RS pGFMS OR FiEPf•ESEMA <br />3- 4 A <br /> <br />ACORD 2SS 3/90 _ _ @ACORD CORPOFIATION 1993 <br />
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