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2015-12-07_REVISION - C1980004
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2015-12-07_REVISION - C1980004
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Entry Properties
Last modified
8/24/2016 6:13:12 PM
Creation date
12/8/2015 8:28:59 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980004
IBM Index Class Name
Revision
Doc Date
12/7/2015
Doc Name
Permit Renewal Application
From
J.E. Stover & Associates, Inc
To
DRMS
Type & Sequence
RN8
Email Name
ZTT
JRS
Media Type
D
Archive
No
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ACORo• CERTIFICATE OF LIABILITY INSURANCEDATEIMM/DD!YYYY) <br />6/[120[6 F 5/28/2015 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />certificate holder ht lieu of such endorsement(s). <br />PRODUCER Lockton Companies <br />Three City Place Drive, Suite 900 <br />St. Louis 1063141-7081 E"t c No <br />(314) 432-0500 <br />RECEIVE 'N NAIC a <br />INSURER A : National Union Fire Ins Co Pittsburgh PA 19445 <br />INSURED Rhino Resource Partners, LP INSURER B: Lexington Insurance Company 19437 <br />1340392 Pikeville KY 41502 JUN Q � 2010 INSURER C <br />INSURER <br />"ON a KECLAIAATI R <br />nrN ire �/-rc� DLTFD L' l`CbTIr11�ATC \II IsaOCO• �� PINK INSURER F DCVialn LI Ell laariFl?- `C3rX3rX3C7r <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />I R <br />TYPE OF INSURANCE <br />9 <br />POLICY NUMBER <br />P Y <br />MID Y <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-0MADE OCCUR <br />N <br />N <br />GLI903168 <br />6/1/2015 <br />6/1/2016 <br />EACH OCCURRENCE 1.,000.000 <br />PO ES $RENTED 1, 000 000 <br />MED EXP one 10,000 <br />PERSONAL a ADV INJURY E 1,000,000 <br />GEN'L AGGREGATE LWIT APPLIES PER <br />POLICYQ JET rX7 LOC <br />OTHER <br />GENERAL AGGREGATE s 2,000,000 <br />PRODUCTS - COMPIOP AGG s2,000.000 <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />}� ANY pALIT <br />NO� gg EE <br />AUTOS D AUTO5ULED <br />NUT0� WNED <br />HIRED AUTOS AlITOS <br />N <br />N <br />CA5775970 <br />6/1/2015 <br />611!2016 <br />OMBIN D SINGLE <br />a CC 5 1000 000 <br />ODILY INJURY (Per person) $ X)Cy_Y )0C <br />BODILY INJURY (Per ecaden! $ X}�{�{}�{ <br />OPERTY G $ XXXXXXX <br />B <br />X UMBRELLA LWB <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS -MADE <br />N <br />N <br />013136615 <br />6/1/2015 <br />6/1/2016 <br />EACH OCCURRENCE S 5,000,000 <br />AGGREGATE $ 5,000,000 <br />DEO I I RETENTION$ <br />Prod Comp Ops $ 5.000,000 <br />WORKEAND EMPLOYERS LIABILITY YIN <br />ANY PRovwET°R MTNEwEXEC VE Q <br />OFFICERMEMSEREXCLUDED? <br />(AIf yy"delory in NH) <br />de�be under <br />DESCRIPTION OF OPERATIONS below <br />N ! A <br />NOT APPLICABLE <br />STATUTE O g <br />E L EACH ACCIDENT $ X3�XXXxx <br />v�v �VVV���vv <br />E L DISEASE - EA EMPLOYEE .fL/1,/`�rW/> xxVxV <br />E L DISEASE- POLICY LOff XX)O J1J1.lf <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, my be attached H mors apace is required) <br />NAMED INSURED INCLUDES MCCLANE CANYON MINING, LLC. MCCLANE CANYON MINE, PERMIT NO. C-1981.004 <br />vcn , ir,vn <br />11318132 <br />DIVISION OF RECLAMATION MINING & SAFETY <br />1313 SHERMAN ST. <br />ROOM #215 <br />DENVER, CO 80203 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE FXPIRAT10N DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />01 <br />The ACORD name and logo are registered marks of ACORD <br />w <br />reserved <br />
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