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AGENCY CUSTOMER ID: <br />LOC #: <br />.4CORI�" Ar%r%1T1f%K1A1 RFRAORKS SC.HFnULE Page _ of _ <br />�' • err■ <br />MUM INSURED <br />AGENCY <br />Aon Risk services southwest, Inc. <br />GCC Energy, LLC <br />FOUCY HUIUBER <br />see certificate Number: <br />CARRIER <br />NAIC CODE <br />see Certificate Number: <br />EFFECTIVE DATE: <br />ANUI I IVnViL RLI•IAl- <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />Additional Desaiption of operations / LODUMS / Vehicles. <br />Re: o5M Permit CO -0106; cDRMS'Permit CO -1981 -035. <br />office of surface Mining western Regional coordinating named as an Additional Insured as required by written <br />contract but limited to the operations of the Insured under said contract, and always subject to the policy <br />terms, conditions and exclusions. <br />BI & PD Coverage <br />XCU Exclusion does not apply <br />�., nnno APMM CnAanPATlnN_ All rinhts reserved. <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />