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2011-03-09_GENERAL DOCUMENTS - C1981025
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2011-03-09_GENERAL DOCUMENTS - C1981025
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Last modified
8/24/2016 4:31:34 PM
Creation date
3/10/2011 7:57:35 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981025
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
3/9/2011
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JRS
SB1
Media Type
D
Archive
No
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r_Ilo.,+t,<• •I??d?a rnnnlulGOn <br />ACORD <br />CERTIFICATE OF LIABILITY INSURANCE "' <br />.M <br />-- 3/07/2011 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER .OF INFORMATION <br />HUB International Ins Svcs Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE - - <br />2742 Crossroads Blvd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Grand Junction, CO 81506 <br />970 245-8011 <br />INSURERS AFFORDING COVERAGE ' - <br />NAIC # <br />INSURED <br /> <br />' INSURER A: Employers Mutual Casualty CO '2141'5--` <br />- <br />- C.B. Minerals Company, LLC <br /> INSURER B: <br />t - PO Box 18?7 <br /> <br />P INSURER C: <br />- <br />ebble, Beach, CA 93953 <br />u. INSURER D: <br />•' 'rr' L INSURER E: CA Resident License #0757776 <br />;COVERAGES <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 />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEPOLICY MM/DDIEFFECTIVEYYYY DATE POLICYMMIEXPIRATION <br />DD/YYYY <br />LIMITS <br />A. GENERAL LIABILITY 1X15286 07/12/2010 07/12/2011 EACH OCCURRENCE <br />- <br />$500,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAG <br />ISES (E. occurrence) E TO RENTED <br />$100,00o'! <br /> _ ' <br /> <br />CLAIMS MADE FXI OCCUR <br />_ <br />MED.EXP. (Any one person) 16, <br />060 <br />.F..w _ <br /> X PD Ded:250 PERSONALS ADV INJURY $500,000 <br /> GENERAL AGGREGATE $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMP/OP AGG $1,000,000 <br /> PRO- <br /> POLICY JECT LOC <br /> AU TOMOBILE LIABILITY - <br />e " <br />COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) _. $ r' <br /> <br />ALLWN(=C?AUTOS, <br /> <br />O <br />y <br />oOJ <br />? <br />?"A <br />_ <br />-. _ <br />BODILY INJURY <br />V!_ <br /> y vCtr .. <br />SCHEDULED AUTOS y <br />P\` _ <br />i= - <br />- <br />(Per'person) <br />$ t?' <br /> _ <br /> HIRED AUTOS. <br />: \$ BODILY INJURY <br /> `J - --- -- <br />(Per accident) .- <br />$ <br /> NON-OWNED AUTOS :. ` <br />t <br /> _, ... PROPERTY DAMAGE ; ; k t ...._.._..,-.. <br /> $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ' <br /> ANY AUTO OTHER THAN EA ACC $ _ ._.._. <br /> AUTO ONLY, <br />AGG <br />$ <br /> EXCESS/ UMBRELLA LIABILITY EACH OCCURRENCE <br /> OCCUR CLAIMS MADE AGGREGATE <br /> <br /> DEDUCTIBLE $ <br /> <br /> RETENTION $ <br />-: <br />$ `? <br /> WORKERS COMPENSATION AND WC ST 7Q= OTH= <br />' EMPLOYERS' LIABILITY . FfL <br />- <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ _ <br /> WF <br />15ER/MEMBER EXCLUDED? <br /> . <br />(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ <br /> if yes describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ <br /> OTHER <br />DESCRIPTION OF-OPERATIONS / LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />RE" - Wort <br />h Thompson Creek Mines <br />f _ <br />CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION: <br />Division of Reclamation, Mining DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN:__ <br />Safety NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL-.-`. <br />1313 Sherman Street Room 215 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS-OR= <br />Denver, CO 80203-2273 REPRESENTATIVES. <br />' AUTHORIZED ._- <br />DRD. 25 (2009101) 1 of 2 #Sl095798IM1078796 (D 1988-2009 ACORD CORPORATION. All rights reserved: <br />The ACORD name and logo are registered marks of ACORD CLO1
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