2015-08-05_GENERAL DOCUMENTS - C2010089

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ACC) " CERTIFICATE OF LIABILITY INSURANCE 7/30/2015 ) 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 Hays Companies Ruan Center, 666 Grand Avenue 17th Floor Des Moines IA 50309 CONTACT Lace Skalick NAME: y y PHONE (515) 802-3006 a/c No: ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A:Lexin ton Insurance Company INSURED Western Fuels -Colorado, LLC 1100 West 116th Ave Westminster CO 80234 INSURER B :National Union Fire Ins. Co INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2015 - 2016 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 UBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ A CLAIMS -MADE a OCCUR 021396066 /1/2015 8/1/2016 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY PRO X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acadent BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE $ Per accident NON -OWNED HIRED AUTOS AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 25,000,000 AGGREGATE $ 25, 000, 000 B EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ $:LO , OOC $ BE84160099 8/1/2015 /1/2016 WORKERS COMPENSATIONI AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ To WC STATU- OTH- RY IM E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED N / A (Mandatory in NH) E L DISEASE - EA EMPLOYE $ E L DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Evidence of insurance as respects New Horizon North Mine in Nucla, CO (Permit #C-2010-089) and New Horizon Mine (Permit #C-81-008). Includes explosives. AUG G S 2015 CERTIFICATE HO MININ D 4j$ ) '7Z OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Colorado Mined Land Reclamation Board ACCORDANCE WITH THE POLICY PROVISIONS. Division of Reclamation, Mining & Safety 1313 Sherman Street, RM 215 AUTHORIZED REPRESENTATIVE Denver, CO 80203 James Hays/ANAPOL ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSI12.1; mmnn;i m Thn Arr)Pr) n�mn -l Innn mrn rnniefnr-1 m rka of Ar:r1Rr1