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2009-12-07_GENERAL DOCUMENTS - C1992080
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2009-12-07_GENERAL DOCUMENTS - C1992080
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Last modified
8/24/2016 3:57:30 PM
Creation date
12/8/2009 2:06:22 PM
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Template:
DRMS Permit Index
Permit No
C1992080
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
12/7/2009
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
TAK
Media Type
D
Archive
No
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ACORD,, CERTIFICATE OF LIABILITY INSURANCE 123(MI /9 "Y) <br />PRODUCER Phone: 9407230771 Fax: 9407615280 <br />Allred-Thompson-Mason-Daugherty Ins. <br />A Division of Higginbotham Agency <br />,. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />1300 10th Street - ? - <br />Wichita Falls, TX 76301 <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURED <br />- INSURERA:Mid-Continent Insurance Com an <br />Oakrid a Energy Inc; Pueblo Mining <br />g INSURERB:Texas Mutual Insurance Comp an <br />4613 Jacksboro Hwy <br />INSURERC: <br />Wichita Falls TX 76302 INSURER D <br /> INSURER E: <br />%.vv r-r%M V CQ <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR DD <br />TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PoucV EXPIRATION LIMITS <br />A GENERAL LIABILITY 04GL000775940 12/5/2009 12/5/2010 EACH OCCURRENCE $ 1000000 <br /> <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $100000 <br /> CLAIMS MADE X OCCUR MED EXP (Any one person) $ Excluded <br /> <br /> i" PERSONAL BADVINJURY $ 1000000 <br /> GENERAL AGGREGATE $ 2 0 0 0 0 0 0 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OPAGG $2000000 <br /> <br /> <br />RO LOC <br />POLICY P <br />JFCT <br />A AUT OMOBILE LIABILITY 04CA002773891 12/5/2009 12/5/2010 COMBINED SINGLE LIMIT 000 <br />000 <br />$1 <br /> X ANY AUTO (Ea accident) , <br />, <br /> <br /> ALLOWNEDAUTOS BODILY INJURY $ <br /> SCHEDULEDAUTOS - (Perperson) <br /> <br /> HIREDAUTOS BODILY INJURY $ <br /> NON-OWNEDAUTOS (Peracadent) <br /> <br /> PROPERTY DAMAGE $ <br /> (Peraocident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> <br /> ANY AUTO OTHERTHAN EAACC $ <br /> AUTO ONLY: AGG $ <br />A EXCESSNMBRELLALIABILITY 04XS164513 12/5/2009 12/5/2010 EACH OCCURRENCE $ 1000000 <br /> OCCUR FICLAIMS MADE AGGREGATE $1000000 <br /> <br />- - <br />DEDUCTIBLE.- -- -- --- <br />- <br />- <br /> R RETENTION $10 00 $ <br />B WORKERS COMPENSATION AND SBP0001027321 7/14/2009 7/14/2010 TORY LIMITS ER <br /> EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1000000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1000000 <br /> <br />, describe under <br />Des <br />ECIAL PROVISIONS below <br /> <br />E.L. DISEASE - POLICY LIMIT <br /> <br />$ 10 <br /> OTHER <br />DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />Carbon Junction Coal Mine, Durango, <br />Colorado Permit #C-92-080 <br />GBKI IFIGA 1 t KUL.L)tK GANGtLL.A 1 IUN <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER <br />Colorado Division of Minerals & Geology WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE <br />1313 Sherman ROOM #1215 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO <br />Denver CO 80203 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON <br />THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED <br />;ORD 25 (2001108) <br />------ _- __ -J?, - - - - .®ACORQCORPORATION 1988
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