2015-02-26_GENERAL DOCUMENTS - C1981038

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BOWIE -1 OP ID: BH A� �© 702=12015 IMMIDDlYYYYI CERTIFICATE OF LIABILITY INSURANCE 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 Central Insurance 4630 Taylorsville Rderrices Louisville, KY 40220 Robert P. Wessel, Jr. CPCU NAME: CT Robert P. Wessel, Jr. CPCU PA1C Na E>n :5 12- 493 -2370 nAIC NO. 502 -493 -2320 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A: National Union Fire 19445 INSURED Bowie Resource Holdings, LLC INSURER 13: Lexin tan Insurance Company Jim Wolff 6100 Dutchman's Lane Ste 902 INSURER C : _ PREMISES Eaoccurrencc Louisville, KY 40205 INSURER 0: $ 10,00 INSURER E : INSURER r: 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 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 TYPE OF INSURANCE POLICY NUMBER MM LTR OCDIYYYY MMfP 7YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,00 CLAIMS -MADE FRI OCCUR GL 6576428 02/01/2015 02/0112016 PREMISES Eaoccurrencc $ 1,000,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,00 PROD U CTS - COMP/OP AGG POLICY E PRO- ❑ LOC JECT $ 2,000,00 Emp Ben. $ 1,000,00 OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ BODILY INJURY (Per person) ANY AUTO $ BODILY INJURY (Per accident) ALL OWNED SCHEDULED S AUTOS AUTOS NON -OWNED PROPERTY DAMAGE Per accident)_ $ HIRED AUTOS AUTOS S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00 AGGREGATE $ - A EXCESS LIAB CLAIMS -MADE I BE12816190 02/01/2015 02/01/2076 ❑ED I X I RETENTIONS 10000 S WORKERS COMPENSATION PER OTH STATUTE ER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTiVE r----1 EL., . EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ I If yes, describe under E.L. DISEASE -POLICY LIMIT .DESCRIPTION OF OPERATIONS below - $ - B Excess Umbrella 02526752 02/01/2015 0210112016 Excess 15,000,00 Umbrella DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Evidence of Insurance as respects to Bowie #2 Mine Permit #01996083 and Bowie #1 Mine Permit #C1981038. General Liability policy provides protections for use of explosives, The General Liability and Umbrella policies include an endorsement providing that 30 days notice of cancellation (or coverage change) will be furnished to the certificate holder by the carrier. CERTIFICATE HOLDER CANC STATEC© SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN State of Colorado ACCORDANCE WITH THE POLICY PROVISIONS. Dept of Natural Resource, Div of Reclamation Mining & Safety AUTHORIZED REPRESENTATIVE 1313 Sherman St, Room 215 Robert P. Wyss I, Jr. P Denver, CO 80230 . ' � a 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD