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Client#: 122718 <br />1.-7=l TiTOTC1t!T <br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE <br />°ATE( " <br />CONS Ssi1VGLE LIMIT <br />(Ea aoafdsAtl <br />7/13/2012 <br />THIS CERTFiCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. 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 pollcy(ies) 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 holier in lieu of such endorsement(s). <br />PRODUCER CW. cT Anita Keller <br />HUB Intemational Ins Svcs Inc PHONE i FAX <br />(ANo, Ext): 970-254-3306 <br />/C, r- (ANo): 866-9-6374 <br />2742 Crossroads Blvd E -NAM anka.keNer@-hubintematonai.com <br />Grand Junction, CO 81506 <br />88$ 245-8011 - INSUREP(S) AFFORDING COVERAGE NAiC 0 <br />INSURER A: Colorado Casualty Insurance Com 141785 <br />INSURED INSURER B: <br />Red Dog Enterprises ------- ------------- --- - <br />---- <br />Darnell Oxford dba: INSURER C: — — - - <br />PO Box 452 INSURER D : <br />Hotchkiss, CO 81419-0452 INSURER E: <br />INSURER F: CA License #0757776 <br />wv I MELIA I c N#I.rrAU=K. RtV1159M <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 CONTRACTOR 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 />D(CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ADOL <br />Ll R TYPE OF INSURANCE - -KMWVD POLICY NUMBER PQi�Y EXP I - -- - LIMITS - <br />A GENERAL LIABILITY X 01 C160532610 7/0212012107/021201 EACH OCCURRENCE_ 51=000,000 <br />X COMMERCIAL GENERAL LIABILITYj pqMqG£ TO RENTED <br />PREMISES Ea ocwrrence $200 000 <br />j CLAIMS-MADEOCCUR <br />I MED EXP (Any one person) S 10 000 <br />i <br />GEN'L AGGREGATE LIMIT APPLIES PER. <br />! POLICY <br />A AUTOIVIOSILE LIAMLITY 01 CI60532610 <br />ANY AUTO _ I <br />i ALL OWNED ( X' SCHEDULED i ! <br />'AUTOS AUTOS <br />X HIRED AUTOS X AUTOS AUTOS <br />NED <br />UMBRELLA LIAR II OCCUR <br />EXCESS UAB 1 CLAIMS -MADE' <br />i <br />r_,D-sFD_ RETENTIONS-- --- <br />WORKERS COIVE14,SATNON <br />AND EMI'LOYEW LW MM Y / N <br />OFFICER ER IXACL WE ECUTIVE; N / A <br />(Mandatory in NH) <br />If yes, describe UrKW <br />'102/2012107/02/201 <br />1 I <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101. Add•Rional Remarks Schedule, if more space is required) <br />State of Colorado, Dept of Minerals & Geology is included as Additional Insured. <br />State of Colorado <br />Div of Mining Safety & Reclamation <br />Yvonne Brannon <br />1313 Sherman St, Room 215 <br />Denver, CO 80203 <br />PERSONAL& ADV INJURY $1,000,000 <br />GENERAL AGGREGATE $2,000,000 <br />PRODUCTS . COMP/OP AGG s 2.000.00A <br />'WC STATU- <br />TORY TORY LIMITS <br />E.L EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYS <br />E L. DISEASE - POLICY LIMIT <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />,s <br />CONS Ssi1VGLE LIMIT <br />(Ea aoafdsAtl <br />---- ---- -- <br />BODILY INJURY (Per person) <br />5 <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />$ <br />Per accident <br />s <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />s <br />'WC STATU- <br />TORY TORY LIMITS <br />E.L EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYS <br />E L. DISEASE - POLICY LIMIT <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />