2014-07-29_GENERAL DOCUMENTS - C1984065

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Client #: 121429 CBMINERA 1—Vo�ILA 0(DS ACORD,. CERTIFICATE OF LIABILITY INSURANCE E (MM /D D/YYYY) 7 DATE(MM/D14 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 CONTACT Shannon Ulrich NAME: PHONE 303 - 382 -5169 FAX 866 - 243 -0727 (A/C, No Ell: A /C, No E-MAIL s: shannon.ulrich@hubinternational.com Grand Junction, CO 81506 888 245 -8011 INSURER(S) AFFORDING COVERAGE NAIC# EMC Insurance Companies INSURER A : p 25186 INSURED CB Minerals Company, LLC c/o Angela Poulton 8717 Delgany Ave #215 Playa Del Rey, CA 90293 INSURER B: $500,000 INSURER C: $100,000 INSURER D X COMMERCIAL GENERAL LIABILITY 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. LTR TYPE OF INSURANCE NSRL WVD POLICY NUMBER MMMDY EFF MMIDDY EXP LIMITS A GENERAL LIABILITY X 1X1528615 7/12/2014 07/12/2015 EACH OCCURRENCE $500,000 PREMISES ERENTED occ nce $100,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � 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 PROJECT LOC - -- AUTOMOBILE LIABILITY Y v COMBINED SINGLE LIMIT E a ccident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS g 201 4 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (par. $ NON -OWNED HIRED AUTOS AUTOS �U` 2 $ K'(1'J�D UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 4.1 �v� ;%0 (,O & gateW J M��1n9 EACH OCCURRENCE $ AGGREGATE $ DIED RETENTION $ $ WORKERS COMPENSATION WC STATU- I OTH- ITORYLIMIT ER AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ECUTIVE� N/A E.L. EACH ACCIDENT $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below > E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT I $ ON DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: DMG permit # C84065 Coal Ridge No. 1 Mine, East of New Castle CO, South of River State of Colorado Division of Minerals and Geology and NCIG Financial Inc are additional insureds for General Liability. ER State of Colorado Division of Minerals and Geology 1313 Sherman St Room 215 Denver, CO 80203 -2273 ACORD 25 (2010/05) 1 of 1 f - g99RR119 /M99RA1nR 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 -11 `- © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PVn1