2015-09-11_GENERAL DOCUMENTS - C1984065

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CI ient#: 121429 CBMINERA ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1 9/08/2015 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 WANED, 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 HUB International Ins Svcs Inc NAME, Betsy Mease PHONE 303 382-5177 F 866 243-0727 A1C No Ext): A C No 2742 Crossroads Blvd E-MAIL y ADDRESS: bets urease hubinternational.com Grand Junction, CO 81506 888 245-8011 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: EMC Insurance Companies 21415 INSURED CB Minerals Company, LLC c/o Angela Poulton 8717 Delgany Ave #215 Playa Del Rey, CA 90293 INSURER 8: INSURER C INSURER D INSURER E INSURER F: CA Resident License #0757776 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 CONTRACTOR 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 ADD INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMBS A GENERAL LIABILITY X 1/31528916 7/12/2015 07112/2016 EACH OCCURRENCE $1,000,000 OMMERCIAL GENERAL LIABILITY PREMISESaoccu ence $100,000 CLAIMS -MADE �OCCUR IX:cPD MED EXP An one person $5,000 PERSONAL &ADV INJURY $1,000,000 Ded:500 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMP/0P AGG $ 2,000,000 $ POLICY PRO- El LOC JECT AUTOMOBILE LIABILITY COMBINEDnt SINGLE LIMIT Ea accide BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS V� e� y BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraccident NON -OWNED HIREDAUTOS AUTOS $ JOS UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE o �ama<� Rena{ety $ EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- TORYLIMIT ER AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVEE OFFICER/MEMBER EXCLUDED? ❑ N I A L EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ (Mandatory in NH) E L. DISEASE - POLICY LIMIT I $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: Coal Ridge No. 1 Mine, Permit C-1984-065 State of Colorado Division of Minerals and Geology and NCIG Financial Inc are additional insureds for General Liability. State of Colorado Division of Minerals and Geology 1313 Sherman St Room 215 Denver, CO 80203-2273 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 _1L © 1988-2010 ACORD CORPORATION. All rights reserved Arnon 7C /1)n4n/nF1 . _1 . rk- Arnon---- --A I.,.....,........;e 4--A.«.. e6 -f Arnon