2015-06-08_GENERAL DOCUMENTS - C1981022

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�1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/01/2015 I 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 NAME_ Aon Risk Services, Inc of Florida 222 Lakeview Avenue PHONE (866) 283-7122 FAX (600) 363-0105 (ATC. No. E%q4 INC, No. ; E-MAIL ADDRESS: Suite 510 West Palm Beach FL 33401 USA INSURER(S) AFFORDING COVERAGE NAIC # 51,000,000 PRF_M_ ISFS fFa n-rsurrnnrel INSURED INSURER A: Zurich American Ins CO 16535 Oxbow Mi ni nq , LLC GENERAL AGGREGATE $10,000,00 INSURER B: 1601 Forum Place — INSURER C: suite 1400 West Palm Beach FL 33401-8101 USA 06/01/2015 INSURER D: COMBINED SINGLE LIMIT $1,000,000 (Ee accdent' INSURER E: BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accidents INSURER F: GUVtKAGt5 GtKI1HIGAlt NUMBtR: b/UUbfdbtiJ9/Z 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. Limits shown are as reauested INER LTR TYPE OF INSURANCE (NSD 114 SUBRI POLICY NUMBER POLICYEXP Mf LIMITS ©1988-2014 ACORD CORPORATION. All rights reserved. X COMMERCIAL GENERrA�L LIABILITY CLAIMS -MADE IX (OCCUR LJ GLO General Liablity SIR applies per policy terlos & COndl l ons EACH OCCURRENCE $2,000,000 51,000,000 PRF_M_ ISFS fFa n-rsurrnnrel MED EXP (Any one person) $10,000 PERSONAL 8 ADV INJURY 11,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO [1] LOC JECT OTHER: GENERAL AGGREGATE $10,000,00 PRODUCTS - COMP/OPAGG $2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BAP 9265950-05 Business Automobile Cover 06/01/2015 06/01/2016 COMBINED SINGLE LIMIT $1,000,000 (Ee accdent' BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accidents UMBRELLA LIABOCCUR EXCESS LV1B CLAIMS -MADE EACH OCCURRENCE AGGREGATE OED RETENTION WORKERS COMPENSATION AND LIABILITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A PER To STATUTE FR E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E L DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Elk Creek Mine Permit #1981 - 022 CERTIFICATE HOLDER CANCELLATION Division of Reclamation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE HATH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE mining and safety 1313 Sherman Street Room 215 Denver Co 80203 USA d � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD