2009-06-04_GENERAL DOCUMENTS - C1981020 ‎(2)‎

• Permit No: C1981020
• 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

k---- CERTIFICATE OF LIABILITY INSURANCE DATE05/30/2009Y)
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 Av enue CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 400 COVERAGE AFFORDED BY THE POLICIES BELOW.
93704
US
Fresno CA A
INSURERS AFFORDING COVERAGE NAIC #
PHONE.[phone] FAX-[phone]
INSURED INSURER A: Federal Insurance Company 20281
CAM Mining LLC dba Central INSURER B
Appalachia Mining LLC
P.O. BOX 1169
ill
KY 41502
Pik
USA INSURER C:
ev
e
INSURER D:
INSURER E:
r0VF.aar.Fc
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 37111019 06/01/2009 06/01/2010 EACH OCCURRENCE $1
000
000
GENERAL LIABILITY ,
,
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000
PREMISES (Ea occurrence)
CLAIMS MADE © OCCUR MED EXP (Any one oersoN
X X Blasting PERSONAL& ADV INJURY $1,000,000

F] GENERAL AGGREGATE $2,000,000

GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OI' AGG
$2,000,000
F] POLICY" El PRO- X? LOC
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AUTOMOBILE LIABILITY a9 r COMBINED SINGLE LIMIT
ANY AUTO
10 (Ea accident )
ALL CIWNED AUTOS 4
ma0?'
k BODILY INJURY
( Per
erson)
SCHEDULED AUTOS a
,?ec
i
? p
HIRED AUTOS t-?1V1$IU(1 Y
gafe
d
( an BODILY INJURY
NON OWNED AUTOS ,•' (Per accident)
PROPERTY DAMAGE
(Pe, accident)

GARAGE LIABILITY' AUTO ONLY - EA ACCIDENT
H ANY AUTO
OTHER THAN EA ACC
AUTO ONLY
AGG
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE
? OCCUR ? CLAIMS MADE AGGREGATE

DEDUCTIBLE

RETENTION
WC STATU- OTH-
WORKERS COMPENSATION AND TORY LIMITS ER

Y/N
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
ANY PROPRIETOR/ PARTNER/ EXECUTIVE
OFFICER/MEMBER EXCLUDED:'
i
NH
!M
d E.L. DISEASE-EA EMPLOYEE
an
atory
n
)
(
E.L. DISEASE-POLICY LIMIT
If yes, describe under SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Munger Canyon Permit #C-1981-020
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CERTIFICATE HOLDER CANCELLATION
Division of Reclamation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
mining and Safety DATE THEREOF, THE ISSUING INSURER WILL I;NP A11QR T^ MAIL
1313 Sherman St., Room 215 ±0 DAYS WR MN. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. -
?14AW 4MP 10114 OR 6- B 'W"
Denver Co 80203 USA O t=
AUTHORIZED REPRESENTATIVE
ACORD 2S (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved=
The ACORD name and logo are registered marks of ACORD