2015-01-14_GENERAL DOCUMENTS - C1992080

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A 7.0 CERTIFICATE OF LIABILITY INSURANCE DATDIYVrrI 12/9/2014 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 NA ME: Sylvia York Allred- Thompson- Mason - Daugherty Ins. A Division of Higginbotham Agency 1300 Tenth Street a"c°Nri Ext :940- 723 -0771 Fvc No :940- 723 -5309 E -MAIL ADDREss: INSURERS AFFORDING COVERAGE NAIC # Wichita Falls TX 76301 INSURERA:Mid- Continent Insurance Company 2/5/2015 EACH OCCURRENCE INSURED 0AKR11 INSURER B:TeXaS Mutual Insurance Company 2 P 4.r) INSURER C: Oakridge Energy Inc 4613 Jacksboro Hwy Wichita Falls TX 76302 INSURER D DAMAGE TO RENTED PREMISES Ea occurrence $100,000 CLAIMS -MADE 171 OCCUR INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 114282624 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 ADDL INSR SIJBR WVD POLICY NUMBER POLICY EFF MMIDDI/YYYY POLICY EXP MMlDDlYYYY LIMITS A GENERAL LIABILITY D4GL000918144 2!5!2014 2/5/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $100,000 CLAIMS -MADE 171 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 X 1 ,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 POLICY PRO LOC $ A AUTOMOBILE LIABILITY 04CA002805828 2!5!2014 2/5/2015 cum ING1717= Ea accident S $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS A UMBRELLA LIAB OCCUR 04XS189341 2!5!2014 2/5/2015 EACH OCCURRENCE $1,000,000 X AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N SBP0001 027321 /14/2014 /14/2015 WC STATU- OTH- TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE❑ E.LEACHACCIDENT $1,000,000 OFFICFR/MFMBFR EXCLUDED? N1A E.L. DISEASE - EAEMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $1 000 000 DESCRIPTION OF OPERATIONS) LOCATIONS )VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requiredl Carbon Junction Mine,La Plata County Colorado The General Liability, Automobile Liability, and Workers' Compensation policy includes an endorsement providing that 30 days notice of cancellation (or coverage change) will be furnished to the certificate holder. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division of Reclamation, Mining And Safety, Department ACCORDANCE WITH THE POLICY PROVISIONS. of Natural Resources 1313 Sherman St., Room 215 AUTHORIZED REPRESENTATIVE Denver CO 80203 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD