2014-12-22_GENERAL DOCUMENTS - C1981018

Home Browse Search

AC'ORU" ►0 CERTIFICATE OF LIABILITY INSURANCE DATE16 /2014 ) 12/16/2014 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 1- 612 - 333 -3323 CONTACT Adam Na Olitan0 NAME: P PHONE FAX No. Ex1: 612 - 333 -3323 (AC. No: 612 - 373 -7270 Hays Companies E -MAIL ana olitano @ha scorn anies.com ADDRESS: P Y P 80 South 8th Street INSURERS AFFORDING COVERAGE NAIC# Suite 700 INSURER A: LIBERTY MUT INS CO 23043 Minneapolis, MN 55402 INSURED INSURER B: CLAIMS -MADE I OCCUR INSURER C: Deseret Generation & Transmission Attn: Robert Dalley 10714 South Jordan Gateway INSURERD: $ 2,000,000 MED EXP (Any one person) $ 10,000 INSURER E: INSURER F: South Jordan, UT 84095 COVERAGES CERTIFICATE NUMBER: 42345768 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 CONTRACT OR 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 INSD WVD POLICY NUMBER MM DDY/YYYY MM /DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY TB2- 641 - 436749 -024 12/30/14 12/30/15 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE I OCCUR PREM SES Ea occur ence $ 2,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY F—] JECT PRO F—] LOC PRODUCTS - COMP /OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY A RECEIVE 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 Q FC Z 2 20 PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR Division of ReclamalJon, EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE Mining & Safety AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE I ER E L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E L. DISEASE - EA EMPLOYE $ E.L DISEASE -POLICY LIMIT 1 $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Deserado Mine in Rangely, Colorado (Permit #C -81 -018). rFRTIFIrATI- Nnl ni=p CANCELLATION ACORD 25 (2014/01) ANapolitano nnInc�co © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE State of Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division of Reclamation ACCORDANCE WITH THE POLICY PROVISIONS. Mining & Safety 1313 Sherman Street Room 215 AUTHORIZED REPRESENTATIVE Denver, CO 80203 USA ACORD 25 (2014/01) ANapolitano nnInc�co © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD