2014-07-29_GENERAL DOCUMENTS - C1981025

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Client #: 121429 CBMINERA e -� ` " 1 `O 7 �- ' ACORD.. CERTIFICATE OF LIABILITY INSURANCE 1 DATE /21/ 7 /DD/YYYY) 7 2014 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 HUB International Ins Svcs Inc 2742 Crossroads Blvd Grand Junction, CO 81506 888 245 -8011 CONTACT Shannon Ulrich NAME: PHONE 303 - 382 -5169 FAX 866 - 243 -0727 (A/C, No E.11: A/C, E-MAIL s: shannon .ulrich @hubinternational.com INSURER(S)AFFORDINGCOVERAGE NAIC# EMC Insurance Com anies INSURER A : p 25186 INSURED CB Minerals Company, LLC c/o Angela Poulton 8717 Delgany Ave #215 Playa Del Rey, CA 90293 INSURER B : EACH OCCURRENCE INSURER C INSURER D INSURER E INSURER F HUB CA License # 0757776 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 CONTRACTOR 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 POLICY EXP MM/DD LIMBS A GENERAL LIABILITY X 1 X1528615 7/12/2014 07/12/201 EACH OCCURRENCE $ 500 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occu ence $100 000 CLAIMS -MADE FA OCCUR MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $500,000 X PD Ded:500 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $1,000,000 $ POLICY PE O LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS py ►CD F"„ +:p ¢, i0 a� PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR 014 EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE 1 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A 9 & Safety WC STATU- OTH- ER E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: North Thompson Creek Mines State of Colorado Division of Minerals and Geology and NCIG Financial Inc are additional insureds for General Liability. aLVIIl12taf_\I;8afa]Ra]aV State of Colorado SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division of Minerals and Geology ACCORDANCE WITH THE POLICY PROVISIONS. 1313 Sherman St Room 215 Denver, CO 80203 -2273 I AUTHORIZED REPRESENTATIVE _11L © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #C9QRAI 13 /M7QRA_,knF PVt'11