2014-08-13_PERMIT FILE - C1981018A (3)

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AcoRO® CERTIFICATE OF LIABILITY INSURANCE °12 232°' 3 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 Hays Companies PHONE FAX 612- 333 -3323 A/C No): 612-373-7270 80 South 8th Street " RE83: Suite 700 EACH OCCURRENCE $ 2,000,000 Minneapolis, MN 55402 INSURERS AFFORDING COVERAGE NAIC0 INSURERA: LIBERTY MUT INS CO 23043 $ 2,000,000 INSURED INSURER S: GENERAL AGGREGATE Deseret Generation & Transmission GEN'L AGGREGATE LIMIT APPLIES PER: S POLICY 7 PRO- iFCT F7 LOC PRODUCTS - COMP /OPAGG Attn: Robert Dalley INSURER C: $ INSURER 0: AUTOMOBILE 10714 South Jordan Gateway INSURERE: South Jordan, UT 84095 INSURER F: COMBI ED SINGLE LIMIT Ea acct snt COVERAGES CERTIFICATE NUMBER: 37622213 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 POLICY NUMBER MM /DD EFF MM /DD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-i] OCCUR TB2- 641 - 436749 -023 12/30/1 12/30/14 EACH OCCURRENCE $ 2,000,000 PREMISES Ea occurrence $ 2,000,000 MED EXP (Anyone person ) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: S POLICY 7 PRO- iFCT F7 LOC PRODUCTS - COMP /OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS ED COMBI ED SINGLE LIMIT Ea acct snt BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ per.�R nDAMAGE $ UMBRELLA LIAR EXCESS LU18 CLAIMS-MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DIED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE [7 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- Y LIMIT E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) Re: Deserado Mine in Rangely, Colorado (Permit #C -81 -018). State of Colorado Division of Reclamation Mining & Safety 1313 Sherman Street Room 215 ,enver, CO 80203 USA 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. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD jhargrove 37622213