2009-06-04_GENERAL DOCUMENTS - C2008086

• Permit No: C2008086
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 6/4/2009
• Doc Name: Certificate of Liability Insurance
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: MPB
• Media Type: D
• Archive: No

CERTIFICATE OF LIABILITY INSURANCE F DATE05/30/2009Y)
V'
PRODUCER
AOn Risk Insurance services west, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Fresno CA Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
5260 North Palm Avenue CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 400 COVERAGE AFFORDED BY THE POLICIES BELOW.
Fresno CA 93704 USA
PHONE.[phone] FAX-[phone] INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445
CAM-Colorado LLC
P.O. BOX 1169 INSURER B:
Pikeville KY 41502 USA INSURER C:
INSURER D:
INSURER E:
('(INFRA(: F.C
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
INSR ADD'
LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE(MM/DD/YYYY DATE(.MM/DD/YYYY)
A GL0936045 05/31/2009 1210112010 EACH OCCURRENCE $1
000
000
GENERAL LIABILITY ,
,
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000,
PREMISES (Ea
n
occurrence)
CLAIMS MADE © OCCUR MED EXP IA
y
one e person) ED
PERSONAL& ADVINIURY $1,000,000

? GENERAL. AGGREGATE $2,000,000

GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OPAGG
$2,000,000
? POLICY ?
LOC
'
I
EC'T
AUTOMOBILE, LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO (Fa accident)
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED ALT OS 1 PC, Pcnon)

HIRED AUTOS ???VE
BODILY INJURY
NON OWNED AUTOS E-%%_ (Per accident)
0 PROPERTY DAMAGE
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GARAGE LIABILITY v
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AUTO ONLY - EA ACCIDENT
- Mi
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ANY AU
OTHERTHAN EA ACC
AUTO ONLY
AGG
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE
? OCCUR ? CLAIMS MADE AGGREGATE

_ EDUCCIBL --

RETENTION
WC ST.ATU- 0TH-
WORKERS COMPENSATION AND
TORY LIMITS

1

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EMPLOYERS' LIABILITY Y?/ N E.L. EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTING
OFFICER/MEMBER EXCLUDED:'
(Mandator
in NH) E.L. DISEASE-EA EMPLOYEE
y L.L. DISEASE-POLICY LIMIT
If yes, describe under SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Red Cliff Mine
State of Colorado, Division of Reclamation Mining & Safety is included as Additional Insured.
*EXcept 10 days notice for non-payment of premium.
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CERTIFICATE HOLDER CANCELLATION
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State of Colorado SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION -~
Division of Reclamation Mining & Safety DATE THEREOF, THE ISSUING INSURER WILL 5A1B6AY8RT MAIL
1313 Sherman St. Rm #215 30 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
Denver Co 80203 USA OANYIUNr„ o
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/01) 01988-2009 ACORD CORPORATION. All rights reserved=
The ACORD name and logo are registered marks of ACORD