2016-04-22_PERMIT FILE - C1981008A (3)

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DATE A �'® CERTIFICATE OF LIABILITY INSURANCE 7/30/2015 Y) 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 'LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED .4PRESENTATIVE 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 NAME: Lacey Skalicky Hays Companies PHONEN. (515) 802-3006 FAX jiUC_Ruan Center, 666 Grand Avenue ADORLSS• 17th Floor INSURERS AFFORDING COVERAGE NAIC # Des Moines IA 50309 INSURER A:Lexin ton Insurance Company INSURED INSURER BNational Union Fire Ins. Co Western Fuels -Colorado, LLC INSURER C: 1100 West 116th Ave Westminster CO 80234 CAVFRAr:FS CFRTIFICATF FJUMRFR2015 — 2016 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 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. INSR LTR LTR TYPE OF INSURANCE ADDL 5 POLICY NUMBER POLICY POLICYEXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABLITY 'AMAIET'RENTI100 000 PREMISES Ea occurrence $ r A CLAIMS -MADE X] OCCUR 021396066 /1/2015 /1/2016 MED EXP (Any one person) $ PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 $ PRO X LOC POLICY F Ij AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea acciden $ _ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per $cadent) $ ALLOWNED SCHEDULED AUTOS AUTOS NON OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per..Iden $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 25, 000, 000 AGGREGATE $ 25, 000, 000 B EXCESS LIAR CLAIMS -MADE DED I X I RETENTION$ $10,000 $ BES4160099 /1/2015 /1/2016 WORKERS COMPENSATION I WC STATU- OTH- I TORY ER AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERFEXECUTIVE E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑N (Mandatory In NH) / A EL DISEASE - EA EMPLOYE $ EL DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Evidence of insurance as respects New Horizon North Mine in Nucla, CO (Permit #C-2010-089) and New Horizon Mine (Permit #C-81-008). Includes explosives. CERTIFICATE HOLDER CANCELLATION Colorado Mined Land Reclamation Board Division of Reclamation, Mining & Safety 1313 Sherman Street, RM 215 Denver, CO 80203 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/ANAPOL2- ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninnst n1 Tho Af ADn nama anti Inn^ aro ranictararl rnartre ^f arnon