2015-09-01_GENERAL DOCUMENTS - C1981035

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A�Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/28/2015 F 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 Aon Risk Services southwest, Inc. Houston TX Office CONTACT NAME: (AICNNo. Ext): (866) 283-7122 jAIIC No.): (800) 363-0105 E-MAIL ADDRESS: 5555 San Felipe Suite 1500 INSURER(S) AFFORDING COVERAGE NAIC # Houston TX 77056 USA INSURED INSURER A: American Zurich Ins Co 40142 GCC Energv. LLC INSURER B: Zurich American Ins Co 16535 6473 County Road 120 Hesperus CO 81326 USA INSURER C: Liberty Insurance Underwriters, Inc. 19917 INSURER D: INSURER E: INSURER F DAMAGE TRENTED $1,000,000 PREMISES Ea occurrence COVERAGES CERTIFICATE NUMBER: 570059161841 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 requested INSIR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MWDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑OCCUR DAMAGE TRENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $4,000,000 OTHER B AUTOMOBILE LIABILITY BAP 6551242-06 09/01/2015 09/01/2016 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS AMAGE Perraccident) $1000 Coll Ded $1000 Comp Ded C X UMBRELLA LAB X OCCUR 100005937505 09/01/2015 09/01/2016 EACH OCCURRENCE $25,000,000 AGGREGATE $25,000,000 LIAB CLAIMS -MADE FEXCESS DED RETENTION Products/Completed O $25,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/ PARTNER/ EXECUTIVE YIN wc655124006 09/01/2015 09/01/2016 X I STATUTE EORH E L EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED F9 (Mandatory in NH) NIA E L DISEASE -EA EMPLOYEE $2,000,000 If yes, descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: OSM Permit CO -0106, CDRMS Permit Co -1981-035. Colorado Division of Reclamation, Mining & Safety is included as Additional insured in accordance with the policy provisions of the General Liability policy. REGEJv SO '7 a0 CD rn 0 0 r. - L0 O Z w l9 V d U CERTIFICATE HOLDER _,n In 1 JZQ b CANCELLATION ivAl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ec�amat1On� EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE n 0j R POLICY PROVISIONS. Colorado Division of Recl arlQN1V & Sa{ety ;�►n9 AUTHORIZED REPRESENTATIVE Mining & safety 1313 Sherman Street, Room 215 �� Y w� JL Denver CO 80203 USA lqen ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD