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2008-10-02_GENERAL DOCUMENTS - C1981014
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2008-10-02_GENERAL DOCUMENTS - C1981014
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Last modified
8/24/2016 3:36:48 PM
Creation date
10/3/2008 10:54:17 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981014
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
10/2/2008
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
KAG
Media Type
D
Archive
No
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ACORD CERTIFICATE OF LIABILITY INSURANCE CSR T5 DATE(MM/DD/YYYY) <br />ENERG-1 09/30/08 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Brown & Brown Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Steamboat Spgs POB 775043 HOLDER. THIS CERTIFICATE DOES NOT AMEND <br />EXTEND OR <br />2130 Resort Drive , <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Steamboat Springs CO 80477-5043 <br />Phone: 970-879-1363 Fax:970-879-0239 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED INSURER A: Arch Insurance Company 11150 <br /> <br />Ener <br />Fu <br />l <br />C <br />ti INSURER B: <br />gy <br />e <br />s <br />orpora <br />on <br />Lindsay Yates INSURER C: <br />PO BOX 7.73457'. <br />Steamboat Springs CO 80477-3457 INSURER D' <br /> INSURER E: <br />u?nv?a <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - <br />L IN <br />TR SR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br /> <br />DATEYMM/DD/YYE <br /> <br />PDA EYMM/DD/YY EXPIRATION <br /> <br />LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br />A X COMMERCIAL GENERAL LIABILITY CSPKGO0243 10/01/08 10/01/09 PREMISES(Eaocourence) $ 100,000 <br /> CLAIMS MADE [K OCCUR MED EXP (Any one person) $ 5 , 000 <br /> PERSONAL & ADV INJURY $ 1 <br />000 <br />000 <br /> GENERAL AGGREGATE , <br />, <br />$ 2 <br />000 <br />000 <br /> , <br />, <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 <br /> X POLICY PRO- LOC <br />JECT <br /> AU TOMOBILE LIABILITY <br /> RECE IVED CO BINED <br />SINGLE LIMIT <br />$ <br /> ANY AUTO Ea accident) <br /> ALL OWNED AUTOS <br /> <br />SCHEDULED AUTOS <br />OCT 011, <br />2 2008 BODILY INJURY <br />(Per person) <br />$ <br /> HIRED AUTOS <br /> <br />Division 01 <br />eciamatlon, BODILY INJURY <br />$ <br /> NON-OWNED AUTOS <br />(Per accident) <br /> Mining a nd Safety <br /> <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO EA ACC <br />OTHER THAN $ <br /> AUTO ONLY: AGO $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR ? CLAIMS MADE AGGREGATE $ <br /> <br /> DEDUCTIBLE <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND <br /> <br />-- - <br />-EMPLOYERS' LIABILITY - "--" <br />-` - <br />- -"-- <br />-? - TORY LIMI3S---- - ER - <br />- <br /> <br /> ANY PROP RIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br />If yes <br />describe under E.L. DISEASE - EA EMPLOYEE $ <br /> , <br />SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER <br />T <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />Reference: Raton Creek Mine: Permit #C-82-055; Kerr Mine: Permit #C-80-006 <br />and Southfield Mine - Permit #C-81-014. <br />Southfield Mine - Permit #C-81-014 <br />t-r-M I INI.A I t MULUtK CANCELLATION <br />CNATURA I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br />Colorado Department of <br />Natural Resources <br />Division of Minerals & Geology <br />1313 Sherman Street, Rm 215 <br />Denver CO 80203 <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />UTH f D REPRESENTATIVE <br />AGUKU Z5 (ZUU9/US) © ACORD CORPORATION 1988
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