2014-10-16_GENERAL DOCUMENTS - C1981025

Home Browse Search

Client #: 123725 SBHOLDIN1 ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE 10/10/2014 (MM/DD (MM /DD/YYYY) 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 e ® Grand Junction, CO 81506 RECEI..,' 888 245 -8011 NAME: Betsy Mease PHONE 303 - 382 -5177 FAx 866- 243 -0727 A/C No Ext : A/C, No E -MAIL bets mease hubnternational.com ADDRESS: y INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Employers Mutual Casualty Compa 21415 INSURED (�T 'I 6 S & B Holdings LLC oll1 I Minrec Inc 627 24 1/2 Rd Unit H Division of Reclamation, Grand Junction, CO 81505 Mining & Safety INSURERS: $100,000 INSURER C : s5,000 INSURER D: $1,000,000 INSURER E: INSURER F: HUB CA License #0757776 $2,000,000 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 SUB WVD POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR X 3X6490415 09/01/2014 09101/2015 EACH OCCURRENCE $110001000 PREMISES EaEaacTuEn.". $100,000 MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- OTH- E.L. EACH ACCIDENT $ $ E.L. DISEASE - EA EMPLOYEE E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: North Thompson Creek Mines, DRMS Permit C- 1981 -025. State of Colorado, Division of Reclamation Mining & Safety is included as an Additional Insured. 30 days notice of cancellation is provided. IlIPf a7 t l a PfG\ INis i PI A■l na I L " -10 Pf a A A_ \t PL` State of Colorado Division of Reclamation Mining & Safety 1313 Sherman St, Rm #215 Denver, CO 80203 ACORD 25 (2010/05) 1 of 1 if wAin11 /M'213innn 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 _11L © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SSnq