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2009-07-30_GENERAL DOCUMENTS - C1984065
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2009-07-30_GENERAL DOCUMENTS - C1984065
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Last modified
8/24/2016 3:49:14 PM
Creation date
7/30/2009 2:43:42 PM
Metadata
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Template:
DRMS Permit Index
Permit No
C1984065
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
7/30/2009
Doc Name
Certificate of Liability Insurance
Permit Index Doc Type
Insurance
Email Name
JRS
Media Type
D
Archive
No
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V I ICI l lfr. I L I -!LJ --" <br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DDffYYY) <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HUB SW Grand Junction HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />2742 Crossroads Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Grand Junction, CO 81506 `' <br />N <br />970 245-8011 ; _I INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />9 INSURER A: Employers Mutual Casualty Compa 21415 <br />IV <br />1 Minerals Company, LLC??1 ? ??00 <br />C.B. INSURER B: <br />ation, <br />Box 1827 <br />PO <br />am <br />acl <br />- <br />INSURER C: <br />1 <br />? <br />Pebble Beach, CA 93953 i)IVtsl?' v and Safety INSURER D: <br />Mining <br /> INSURER E: <br />L'uV tItAV CJ <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />ANY REQUIREMENT <br />, <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 /> POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY <br /> ERAL LIABILITY I X1528610 07/12/09 07/12/10 EACH OCCURRENCE $500.000 <br />A GEN MMERCIAL GENERAL LIABILITY DAMAGES f RENTED <br />Fn nccurrence) $100,000 <br /> X CO <br />D CLAIMS MADE a OCCUR MED EXP (Any one person) $5 000 <br /> X d:250 <br />PD D PERSONAL & ADV INJURY <br />0 <br />s500.000 <br /> e GENERAL AGGREGATE $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000 <br /> <br /> <br />PRO- <br />POLICY PRO- LOC <br /> <br /> LIABILITY COMBINED SINGLE LIMIT $ <br /> <br />ANY AUTO (Ea accident) <br /> <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> <br />SCHEDULED AUTOS (Per person) <br /> <br /> HIREDAUTOS BODILY INJURY $ <br /> <br />OWNED AUTOS <br />NON (Per accident) <br /> - <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> <br /> ANY AUTO OTHER THAN EA ACC S <br /> R AUTO ONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> I OCCUR FICLAIMS MADE AGGREGATE $ <br /> <br /> <br /> DEDUCTIBLE $ <br /> <br /> RETENTION $ $ <br /> OTH- <br />WC STATU- <br /> WORKERS COMPENSATION AND <br />__. EMPLOYERS'-LTABICITY-- - <br />E.L. EACH ACCIDENT <br />$ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ <br /> If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br /> OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />DMG Permit No. C-84-065 - Coal Ridge No. 1 Mine, East of <br />New Castle,CO South of the River. NCIG Financial, Inc. and the State of <br />Colorado Division of Minerals & Geology are included as Additional <br />Insureds. **or incur substantive changes or failure to renew. <br />(See Attached Descriptions) <br /> <br />State of Colorado <br />Division of Minerals & Geology <br />1313 Sherman Street, Room 215 <br />Denver, CO 80203 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL XK%)1(JrlRJC%MAIL 10- DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ?b7tK97 K <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2001/08) 1 of 3 #S2052"/M197628 AK01 " "`'"r"' .,vnrv^., r ... r.".
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