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/EMClnsurance Companies <br />EMPLOYERS MUTUAL CASUALTY COMPANY <br />C.B. MINERALS COMPANY LLC <br />POLICY NUMBER: lDl- 52- 86 --- 1 <br />EFF DATE: 07/12/14 EXP DATE: 07/12/1 <br />G E N E R A L L I A B I L I T Y P 0 L I C Y <br />D E C L A R A T I O N S <br />ENDORSEMENT SCHEDULE <br />NAME: <br />STATE OF COLORADO DIVISION OF <br />MINERALS AND GEOLOGY <br />1313 SHERMAN ST, ROOM 215 <br />PROJECT ADDRESS: <br />COAL RIDGE NO 1 MINE SOUTH OF <br />THE RIVER EAST OF NORTH EAST <br />CASTLE, CO 81647 <br />*CG7501 10 -13 AI -DESIG PERSON /ORGAN -VICAR LIAB <br />NAME /CONCESSIONAIRES /JOB TITLES/ <br />POLITICAL ENTITY /ASSOC. OR ORG. /ETC. <br />NCIG FINANCIAL, INC. <br />PO BOX 1827 <br />PEBBLE BEACH CA 93953 <br />STATE OF COLORADO DIVISION OF <br />MINERALS AND GEOLOGY <br />1313 SHERMAN ST, ROOM 215 <br />CG7584 10 -08 MOBILE EQUIPMENT /AUTO AMENDMENT <br />*CG8081 04 -06 FUNGI /BACTERIA NOTICE TO POLICYHOLDR <br />DATE OF ISSUE: 07/01/14 (CONTINUED) <br />FORM: IL7131A (ED. 04 -01) 101 SB 1D15286 1503 <br />EDITION <br />FORM <br />DATE <br />DESCRIPTION /ADDITIONAL INFORMATION PREMIUM <br />------------------------------------------------------------------------------ <br />*CG0001 <br />04 -13 <br />COMMERCIAL GEN LIABILITY COV FORM <br />CG0300 <br />01 -96 <br />DEDUCTIBLE LIABILITY INSURANCE <br />APPLICATION OF ENDORSEMENT (LIMITATIONS): <br />$500 DEDUCTIBLE APPLES TO PD PER OCCUR <br />CG2146 <br />07 -98 <br />EXCL -ABUSE OR MOLESTATION <br />CG2147 <br />12 -07 <br />EXCL- EMPLOYMENT RELATED PRACTICES <br />*CG2150 <br />04 -13 <br />AMENDMENT /LIQUOR LIABILITY EXCLUSION <br />CG2167 <br />12 -04 <br />FUNGI OR BACTERIA EXCLUSION <br />CG2170 <br />01 -08 <br />CAP /LOSSES FROM CERT ACTS /TERRORISM <br />CG2176 <br />01 -08 <br />EXCL PUNITIVE DMGS ACTS OF TERRORISM <br />CG2294 <br />10 -01 <br />EXCL -DMG TO WORK PERFORMED BY SUB <br />*CG7001A <br />10 -12 <br />GENERAL LIABILITY SCHEDULE <br />*CG7003 <br />10 -13 <br />GL QUICK REFERENCE (OCCURRENCE) <br />CG7191 <br />01 -13 <br />COMM'L GENERAL LIABILITY AMENDMENT <br />*CG7315.2 <br />10 -13 <br />CONTINUOUS OR PROGRESS INJ /DMG EXCL <br />CG7422 <br />08 -00 <br />EXCL INJ /DAMAGE FROM EARTH MOVEMENT <br />*CG7480 <br />10 -13 <br />AI- OWN,LESSEE,CONTRACTOR -VICAR LIAB <br />NAME: <br />NCIG FINANCIAL, INC. <br />PO BOX 5460 <br />PLAYA DEL REY CA 90296 <br />PROJECT ADDRESS: <br />COAL RIDGE NO 1 MINE SOUTH OF <br />THE RIVER EAST OF NORTH EAST <br />CASTLE, CO 81647 <br />NAME: <br />STATE OF COLORADO DIVISION OF <br />MINERALS AND GEOLOGY <br />1313 SHERMAN ST, ROOM 215 <br />PROJECT ADDRESS: <br />COAL RIDGE NO 1 MINE SOUTH OF <br />THE RIVER EAST OF NORTH EAST <br />CASTLE, CO 81647 <br />*CG7501 10 -13 AI -DESIG PERSON /ORGAN -VICAR LIAB <br />NAME /CONCESSIONAIRES /JOB TITLES/ <br />POLITICAL ENTITY /ASSOC. OR ORG. /ETC. <br />NCIG FINANCIAL, INC. <br />PO BOX 1827 <br />PEBBLE BEACH CA 93953 <br />STATE OF COLORADO DIVISION OF <br />MINERALS AND GEOLOGY <br />1313 SHERMAN ST, ROOM 215 <br />CG7584 10 -08 MOBILE EQUIPMENT /AUTO AMENDMENT <br />*CG8081 04 -06 FUNGI /BACTERIA NOTICE TO POLICYHOLDR <br />DATE OF ISSUE: 07/01/14 (CONTINUED) <br />FORM: IL7131A (ED. 04 -01) 101 SB 1D15286 1503 <br />