2015-12-28_GENERAL DOCUMENTS - C1981018

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A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 12/22/2015 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 80 South 8th Street Suite #700 Minneapolis MN 55402 ONTACTNAME: p Adam Na olitan0 CONTACT-NAME: PHONE (612)333-3323 �C No, 612-373-7270 ADDRESS•anapolitano@hayscompanies.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Liberty Mutual Fire Insurance Co 23035 INSURED Deseret Generation & Transmission Attn : Robert Dalley 10714 South Jordan Gateway South Jordan UT 84095 INSURER B INSURER C: INSURER D: INSURER E: _ INSURER F: CrlivroAnpQ CERTIFICATE NUMBFR2015 - 2016 REVISION NUMBER: v THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INUICAiED NOTWITHSTANDING ANY REQUIREMENT, TERIO 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 INSRT LTR TYPE OF INSURANCE IN5D WVDSUBI EFF POLICY NUMBER MM/DD/YYYY MLICY EXP M DY IYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 1J GEN'L AGGREGATE LIMIT APPLIES PER XJ POLICY ` PRO- �� LOC OTHER TB2-641-436749-025 12/30/2015 12/30/2016 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 2 000 , 000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $ _ 2,000,000 GENERAL AGGREGATE $ 2, 000,000 _ PRODUCTS -COMP/OP AGG 2,000,000 r $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED�SCHEDULED ._ AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS rvEo (Ea aBcideDtSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAR OCCUR EXCESS LIABCLAIMS-MADE I0f N / A 2015 DE� � R ee`arnat1O p;VlSlOn & SafetY ' EACH OCCURRENCE $ _ AGGREGATE $ DED 11 i RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE 7�I OFFICER/MEMBER EXCLUDED (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ $ STATUTE EERH E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYE $ E L DISEASE - POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Deserado Mine in Rangely, Colorado (Permit #C-81-018). GERTIFIGAft- HULUtK W., State of Colorado Division of Reclamation 1313 Sherman Street Room 215 Denver, CO 80203 ACORD 25 (2014/01) INS025 nnt4m i 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 Hays/ANAPOL W -I V00 -Au 14 AV\Jr[N %0Wr[rv1r%n r rvn. nn I U , ......... The ACORD name and logo are registered marks of ACORD