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OP ID: BW A °T CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 01/1 2/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 303-444-4666 CONTACT Hix Insurance Associates,Inc. 303-444-8481 PHONE FAX 3005 Center Green Dr.Ste 120 (A/C.No.Exn: (NC,No): Boulder,CO 80301 E-MAIL ADDRESS: Charles Hix PRODUCER HIGHL-8 CUSTOMER ID B: INSURER(S)AFFORDING COVERAGE NAIC B INSURED Highland Ditch Company INSURER A:American Alternative Insurance Jill Baty INSURER B:Pinnacol Assurance 41190 PO Box 649 Mead,CO 80542 INSURER C INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE 7CO61 SUBR POLICY EFF POLICY EXP LIMITS LTR INSR NA/D POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X GPPAPF6053196-01 11/01/11 11/01/12 PRMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence] $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL 8,ADV INJURY $ 1,000,000 X D&O/EPLI w/retro GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 Xl POLICY —I INT LOU Emp Ben. $ 1,000,000 JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) -. - _ _.. -._ - A X ANY AUTO GPPAPF6053196-01 11/01/11 11/01/12 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS y ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y( N!A 4127534 11/01/11 11/01/12 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Colorado Water Conservation Board is listed as an Additional Insured with respects to General Liability CERTIFICATE HOLDER CANCELLATION COLOWAT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Colorado Water THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Conservation Board ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Steven Shull 1313 Sherman St AUTHORIZED REPRESENTATIVE Denver,CO 80203 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD