GENERAL44416

• Permit No: C1981047
• IBM Index Class Name: General Documents
• Doc Date: 6/2/2003
• Doc Name: Certificate of Liability Insurance
• To: DMG
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

acoRn CERTIFICATE OF LIABI LITY INSURANCE OP ID P DATE (MM/DD/YY)
EMCO 1 05/30/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION

Blanchard Insurance Group Znc. a i
` ~LDER T H S CERTIFI ATE DOES NOT AMENDREXTEND OR

P.O. HOx 60130 V
`
~~
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Grand Junction CO 81506 ~
Phone: [phone] Fax:[phone] ~ nn~~'~ INSURERS AFFORDING COVERAGE
W
INSURED , INSU
RE \OB~EmplOyer3 Mutual Casualty Co.

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AS~B~Di MAC M
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INSURER C: '
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715 HOrl ZOn
Grand Junction C~ 81506 OTI INSURER D:

INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACTOR OTHER DOCUMENT W ITN RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR
MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY NUMBER DATE HAND DATE MM/DD/YV LIMITS
GENERAL LIABILITY EACH OCCURRENCE $iT OOOTOOO
A X COMMERCIAL GENERAL LIABILITY 9X90868 05/10/03 05/10/04 FIRE DAMAGE(Any one lire) $ 100,000
CIAIMS MADE O OCCUR MED EXP (Any one person) $ $ ~ OOO
PERSONALB ADV INJURY $1~000~000
GENERAL AGGREGATE $ 2 ~ OOO ~ OOO
GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS-COMPN)P AGG $2~000~000
POLICY JECo-T LOC
AU TOMOBILE LU\BILRY COMBINED SINGLE LIMIT
§1,000,000
A X ANVAUro 9X90868 05/10/03 05/10/04 (Eaaaident)
ALL OW NED AUTOS
BODILY INJURY

(Per parson) §
SCHEDULED AUTOS
X HIRED AUTOS BODILY INJURY
$
X NON-OW NED AUTOS (Per aocitlem)
PROPERTY DAMAGE

'
(Per accident) §
GARAGE LIABILRY AUTOONLV-EA ACCIDENT S
ANV AUTO OTHER THAN EA ACC §
AUTO ONLY: AGG $
EXCESS UABlLITY EACH OCCURRENCE $
OCCUR ~ CLAIMS MADE AGGREGATE $
E
DEDUCTIBLE S
RETENTION E $
WORKERS COMPENSATION AND TORY LIMITS ER
EMPLOYERS' LIABILRY
E.L. EgCM ACCIDENT E
E.L DISEASE-EA EMPLOYE §
E.L. DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS20CATIONSNEHICLES~EXCLUEIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Blue Ribbon Mine-File No C-81-047. State Of Colorado, Division Of
Minerals & Geology is included as an Additional Insured.*10 Days Notice Due
to Non-Payment Of Premium.**Or incur substantive changes or failure to
renew.
CERTIFICATE ROLUtR N ADDITK)NAL INSURED; INSURER LETTER:_ I:ANI:ELLAIIVPI
OOOOOOO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
State Of COlOradO DATE THEREOF, THE ISSUING INSURER WILL mm~IDMAIL *30 DAYS WRITTEN
D1v1S1On Of MlneralB & Geology NOTICE TO THE CERTiFlCATE HOLDER NAMED TO THE LEFT, ptlp7QM[mpeKgLh{
1313 Sherman Street Room 215 ~o~wcnr'mr3mac®xeLpro7-nwx®saammRLm5mm7R~xgac;&>ms:Dx
Denver CO 80203 ~~~~~ \\\