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GENERAL46580
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GENERAL46580
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Entry Properties
Last modified
8/24/2016 8:20:33 PM
Creation date
11/23/2007 2:45:39 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1983059
IBM Index Class Name
General Documents
Doc Date
7/30/2007
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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.. ,.,...._ _.._... ', .. '- DATECMM/DD/YY) <br />_ACORDn I C GRTIFICATE OF LIABILITY INSURANCE .4..,_ . o~/za/o~ <br />PROOUCPa <br /> <br />Aon Risk services, inc of Florida <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />222 Lakeview Avenue AND CONFERS NO RIGHTS UPON TI1E CERTIFICATE HOLDER. THIS <br />Suite 510 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />West Palm Beach FL 33401 USA COVERAGE AFFORDED BY THE POLICIES BELOW. <br />PxoNE~ 866 283-7124 PA.X- 866) 430-1035 INSURERS AFFORDING COVERAGE <br />INSURED INSURER A. American Internaii onal Specialty Lines <br />Oxbow Carbon & Minerals LLC B\B SURER e: Hartford Fire Insurance CO. <br />1601 Forum, P1 Q~CE4~~ <br />Attn: Donna 7. Gulbransen 1~ INSURERC PdCi fiC Indemnity co <br />west Palm Beach FL 33401-8101 USA <br />~~~ 3 0 200 <br />INSURERD WestChestef Fire Insurance co <br />1 <br /> INSURER E'. <br />' VERAGES~S71us:CeitifiLate is not intended tos ~ aYerB es tedns'tonditions and'exeluslon'sbEtNe "lioiessfiown SIR; May App: ;y <br />THE POLICIES OF MSURANCE LISTED BELOW HAVE B SURED NAMED ABOVE FOR THE POLICY PERIOD MDICATED, NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED Oft MAY <br />PERTAJN, THE fNSURANCE AFFORDED BY' THE POLICIES DESCRIBED HEREI N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDJTIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OP INSURANCE <br />POLICY NUMBER pOLICY EFFECTIVE POLICY EXPIRATION <br />LIMTI'S <br /> pATE(MM1DD\YY) DATE(MM\OD\VV) <br />L cenERAL LUmLrrv 35863379 <br />l <br />i <br />i 06)01/06 06/O1J07 EACH OCCURRENCE bl, ODD, 000 <br /> <br />X <br />COMMERCIAL GENERAL IIABILRY Genera <br />L <br />ty <br />abil <br />FIRE DAMAGEIMyoce fire) <br />51,000,000 <br /> CLAIMS MApE~OCCUR MED EXP (Any ore person) E10, 000 <br /> PERSONALS ADV INIURY E1, 000, 000 <br /> GENERAL AGGREGATE SZ,000, 000 <br /> <br /> CENL AGGREGATE LIMB APPLIES PER <br /> PRODUCTS-COMP/OP AGG 52 <br />000,000 <br /> ^ PRO- ^ , <br /> POLICY IECr LOC <br />B wmoMOBILE LUganv 20uENZQ6228 09/01/05 09/01/06 CONNED SINGLE UiwT <br /> RUSt Re55 AUCORIDbIIe (Ea xcidrnt) 57,000,000 <br /> X ANY AGTD <br /> ALL OWNED AVfOS BODILY INIURY <br /> SCHEDULED AUTOS (Per pc'sop) <br /> (BRED AUTOS BODILY INIURY <br /> NON OWNED AVFOS (Per xcident) <br /> PROPERTY DAMAC~ <br /> (Pw <br />idmtl <br /> au <br /> GAIACE LLABILrrY AUI'OONLY- EA ACCIDENT <br /> ANY AUTO OTIDRTHAN EA ACC <br /> AUfOONLY: <br /> AGG <br />D ccc,<ss LUBILLrv G 7 <br />ll <br />bili <br />b <br />i 06/01/06 0 EACH OCruRRBNCE S2E, 000, 000 <br /> <br />X OCRRL ^ CLARAS MADE Um <br />re <br />a L <br />a <br />ty <br />AGGREGATE <br />125,000,000 <br /> <br /> nED11CIm1E <br />- - X -°.^IEImOH 11 - -- <br /> TYORRPASCOMPHi$ATgN AND <br />' C STATU- OTH- <br />RY ER <br /> dPlOYOtR <br />LIABII.RY EL EACH ACCmEM <br /> E L DISEAS~POLICY LIaO'1' <br /> E.L DISEASE-EA EMPLOYEE <br />~ <br />A PL59E28238 09/29/03 09/29/06 Limit (1) 550, 000, 000 <br /> ~~ <br />Pollution Legal liability , <br /> X wTl Legal Liab <br />DESCRRIBW OF OPERAIlONS1.OCATI0N5/VEFBCLESIEXCLUSIONS ADDED BY ENDORSEMEM/$PECIALFROVISIONS I <br />RE: Terror Creek company. c-1983-059. of vi si on of Mi nerals & Geology is named as an Additional Insured exc}udi ng <br />workers' compensation and Employers' Liability as required by written contract but limited to the operations of <br />the insured under said contract, and always subject to the policy terms, conditions and exclusions. i <br />i <br />Division of Reclamation, Mining & Safety SHOULD ANY OF'THE ABOVE DESCRmED POHCIES BE CANCELLED BEFORE THE EXPIRATION <br />1313 Sherman Street, ROOM 215 DATE TftEREOP. THE LSSUMG COMPANY WBl BiBb\VOR-TB MAIL <br />Denver Co 80203 OSA TO DAYS WRITTEN NOTICE TO THE CERTIFlCATE HOLDER NAMED lY) THE LEFT, <br /> AUFHORIZED REPRESEMATIVE /~ /_ /J~J ,.~_~_ <br />Gln.._:! .. v~ <br />d <br />r <br />4 <br />u <br />g <br />0 <br />'~ <br />0 <br />N <br />0 <br />r <br />z <br />u <br />A <br />u <br />W <br />i. <br />u <br />V <br /> <br />
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