2013-12-11_GENERAL DOCUMENTS - C1992080

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® DATE (MMIDD /YYYY) 'ORD CERTIFICATE OF LIABILITY INSURANCE , DATE( MJ 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 CONTACT NAME: Sylvia York Allred- Thompson- Mason - Daugherty Ins. PHONE FAX kDivisionofHigginbotham Agency MAIoE<t:940- 723 -0771 AlcNo:940 -72 -5309 1300 Tenth Street ADDRESS:Syork&hiQg In botham -net Nichita Falls TX 76301 R�CEIV INSURER(S) AFFORDING COVERAGE NAIC k INSURED OAKRD[C I I LV tJ Oakridge Energy Inc 4613 Jacksboro Hwy TION Wichita Falls TX 76302 DMM`� NG AND SAFETY F: COVERAGES CERTIFICATE NUMBER: 13F1 ?339701 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. I�TR TYPE OF INSURANCE IINSR W POLICY NUMBER POLICY EFF ±OLICYrrW LIMITS B GENERAL LIABILITY D4GL000894659 2/5/2013 2/5/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAM RENTED PREMMI SES Ea occurrence) $100,000 MED EXP (Any one person) $ CLAIMS -MADE FI OCCUR X 1000 PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO LOC $ B AUTOMOBILE LIABILITY 04CA002799916 2/5/2013 121512014 Ea accident ) $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS 'AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED - AUTOS PROPERTY DAMAGE Peraccident $ $ B UMBRELLA LIAB OCCUR 04XS184859 215/2013 1 2/5/2014 EACH OCCURRENCE $1,000,000 X AGGREGATE $1,000,000 EXCESS LWB CLAIMS -MADE DFD x RErFNIION$10.000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER)EXECUTIVE OFFICER/MEMBER FXCLUDEI ❑ N 1 A SBP0001027321 /14/2013 T11 4/2014 TORY L MIT OTR F.L. EACH ACCIDENT $1,000.000 E.L. DISEASE - EA EMPLOYEE $1,000.000 (Mandatory in NH) If yes, describe antler E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Carbon Junction Mine,La Plata County Colorado The General Liability, Automobile Liability, and Workers' Compensation policy includes an endorsement providing that 30 days notice of cancellation (or coverage change) will be furnished to the certificate holder. L.S"L9i11 I P11 i L•l III ■J PI L1 Division of Reclamation, Mining And Safety, Department of Natural Resources 1313 Sherman St., Room 215 Denver CO 80203 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD