2014-10-16_GENERAL DOCUMENTS - C1981047

Home Browse Search

Client #: 123725 SBHOLDIN1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 10/10/2014 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 CONTACT Betsy Mease HUB International Ins Svcs Inc PHONE 303 - 382 -5177 FAX 866- 243 -0727 (A/C, No Ell: : AIC, No 2742 Crossroads Blvd E -MAIL y ADDRESS: bets mease hubnternational.com Grand Junction, CO 81506 09/01/2015 EACH OCCURRENCE $110001000 INSURER(S) AFFORDING COVERAGE NAIC# 888 245 -8011 INSURER A: Employers Mutual Casualty Compa 21415 INSURED INSURER B: PREMISES (E. RENTED S & B Holdings LLC CLAIMS -MADE FxI OCCUR Minrec Inc INSURER C 627 24 1/2 Rd Unit H INSURER D: PERSONAL & ADV INJURY $1,000,000 Grand Junction, CO 81505 INSURER E: HUB CA License #0757776 INSURER F: 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 /DDYYY /Y POLICY EXP /Y MM /DDYYY LIMITS A GENERAL LIABILITY X 3X6490415 9/01/2014 09/01/2015 EACH OCCURRENCE $110001000 X COMMERCIAL GENERAL LIABILITY PREMISES (E. RENTED $100 1 000 CLAIMS -MADE FxI OCCUR MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 RECEIVED GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $2,000,000 X POLICY PRO JECT E LOC $ AUTOMOBILE LIABILITY ANY AUTO OCT 1 C 2014 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS Division of Reclarnationi Mining &Safety BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION WC STATU- I OTH- TORY LIMIT ER AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ N/A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) It 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: Blue Ribbon Mine - File No C -81 -047. State of Colorado, Division of Minerals & Geology is included as Additional Insureds. State of Colorado Division of Minerals & Geology 1313 Sherman St, Room 215 Denver, CO 80203 ACORD 25 (2010/05) 1 of 1 iv wi,in•I new vinnn 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 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SSn4