2014-01-21_GENERAL DOCUMENTS - C1981018

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ACC? " CERTIFICATE OF LIABILITY INSURANCE DATE2 /Y3 12/ 23 /2 01 3/23 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 1- 612 - 333 -3323 CONTACT Hays Companies NAME: PHONE FAX A/c. No Ext: 612 - 333 -3323 A/C No: 612 - 373 -7270 E -MAIL ADDRESS: 80 South 8th Street Suite 700 EACH OCCURRENCE $ 2,000,000 Minneapolis, MN 55402 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: LIBERTY MUT INS CO 23043 INSURED INSURER B $ 2,000,000 Deseret Generation & Transmission CLAIMS -MADE � OCCUR Attn: Robert Dalley INSURER C: INSURER D: MED EXP (Any one person) 10714 South Jordan Gateway INSURER E: $ 2,000,000 South Jordan, UT 84095 INSURER F COVERAGES CERTIFICATE NUMBER: 37622213 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD /YYYY LIMITS A GENERAL LIABILITY TB2- 641 - 436749 -023 12/30/1 12/30/14 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 2,000,000 CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ 2,000,000 X POLICY JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under 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) Re: Deserado Mine in Rangely, Colorado (Permit 4C -81 -018). CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) jhargrove 37622213 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE State of Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division of Reclamation ACCORDANCE WITH THE POLICY PROVISIONS. Mining & Safety 1313 Sherman Street Room 215 AUTHORIZED REPRESENTATIVE Denver, CO 80203 71�1� USA ACORD 25 (2010/05) jhargrove 37622213 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD