2015-09-11_GENERAL DOCUMENTS - C1984065 (2)

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Client#: 121429 IH:1 TJIIL,I=1:7_' ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 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 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 HUB International Ins Svcs Inc TACT NAME: Betsy Mease PHONEFAX 866 243-0727 A1C No 303 382-5177 Ext): A1C No : 2742 Crossroads Blvd E-MAIL y ADDRESS: bets urease hubintemational.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 B: 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD1YYYY LIMITS A GENERAL LIABILITY X 1 D1528916 7/12/2015 07112/2016 $11,000,000 GENERAL LIABILITY EEAACCHp�OECTCURRENCE PREMISES Eao�rrence $100,000 CLAIMS -MADE N OCCUR IXCOMMERCIAL MED EXP (An one person $5,000 PERSONAL &ADV INJURY $1,000,000 PDDed:500 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY PRO JECT n LOC �``'vV $ AUTOMOBILE LIABILITY ` COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS 1 S�-QQ�0 ` S C P�'a ` OER •4Oo o^• O BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ UMBRELLA LIABOCCUR UAB AB HCLAIMS-MADE O`v�s�g& `v` EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION WC STATU-IMITS OTH- TORYANY AND EMPLOYERS' LIABILI Y Y I N PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N 1 A EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 1011, AddMnal Remarks Schedule, it more space is required) Project: DMG permit # C84065 Coal Ridge No. 1 Mine, East of New Castle CO, South of River 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 -1a © 1988-2010 ACORD CORPORATION. All rights reserved Arn Dn']C 1']fl4fl1flC% • _c • Tk- A!`nDrl ..w- - --A 1...... -- r....:e.4.+r.+.l..+.+rl. -IF Af`n Dr%