2013-09-09_GENERAL DOCUMENTS - C1981035

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ACO/20 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM /2013 Y) 08/30/20 t 3 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 Aon Risk Services Southwest, Inc. RECEIVED Houston TX Office CONTACT NAME. PHONE (866) 283 -7122 FAX (800) 363 -0105 (A/C. No Ext): AIC No.), E-MAIL ADDRESS. 5555 San Felipe Suite 1500 Houston TX 77056 USA 0 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: American Zurich Ins CO 40142 GCC Energy, LLC 6473 County Road 120 DIVISION OF RECLAMATION Hesperus Co 81326 USA MININGAND SAFETY INSURER B: Zurich American Ins CO 16535 INSURER C: Liberty insurance underwriters, Inc. 19917 INSURER D: $1,000,000 INSURER E: CLAIMS -MADE ❑ OCCUR INSURER F. COVERAGES CERTIFICATE NUMBER: 570051149365 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD MWDD LIMITS A GENERAL LIABILITY GLO 0 EACH OCCURRENCE 2 , 000 , 000 $2,000,000' X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence ) $1,000,000 CLAIMS -MADE ❑ OCCUR MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $4,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $4,000,000 X POLICY PRO LOC JECT B AUTOMOBILE LIABILITY BAP 6551242 -04 09/01/2013 09/01/2014 COMBINED SINGLE LIMIT a accident) $1,000,000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $1000 Coll Ded $1000 Comp Ded C X UMBRELLA LIAB X OCCUR 100005937503 09/01/2013 09/01/2014 EACH OCCURRENCE $25,000,000 EXCESS LU1B CLAIMS -MADE AGGREGATE $25,000,000 DED RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/ PARTNER / EXECUTIVE Y❑ N WC655124004 09/01/2013 09/01/2014 X TORY LIMITS ORH E L EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED, (Mandatory in NH) N/A E L DISEASE -EA EMPLOYEE $2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) See Attached: Re: OSM Permit CO -0106; CDRMS Permit Co- 1981 -035. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Colorado Division Of Reclamation, AUTHORIZED REPRESENTATIVE Mining & Safety 1313 Sherman Street, Room 215 Denver CO 80203 USA �L(Jldi/ip ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD