2016-06-13_GENERAL DOCUMENTS - C1981022 (2)

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At✓ o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/02/2016 I 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 have ADDITIONAL INSURED provisions or 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 Aon Risk Services, Inc of Florida-NAME. 222 Lakeview Avenue CONTACT (AIC No. Ext). (866) 283-7122 FAX No): (800) 363-0105 E-MAIL ADDRESS: Suite 510 West Palm Beach FL 33401 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich American Ins CO 16535 Oxbow Mi ni nQ, LLC INSURER B: 1601 Forum Place INSURER C: Suite 1400 INSURER D: West Palm Beach FL 33401-8101 USA INSURER E: AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY INSURER F: COVERAGES CERTIFICATE NUMBER: 570062334271 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. Limits shown are as requested INSIR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MWDD POLICY fMWDD= LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEX❑ OCCUR GLO SIR applies per policy terns _ & conditions EACH OCCURRENCE $2,000,000 DAMAGE TRENTED$1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY ❑ PRO 1 LOC JECT OTHER GENERAL AGGREGATE $10,000,000 PRODUCTS - COMP/OP AGG $2,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY BAP 9265950-06 06/01/2016 06/01/2017 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident) UMBRELLA LUU3 EXCESS LIAB OCCUR CLAIMS -MADE Jr iu j oC^ �MS��N r1C REC LAWrIm EACH OCCURRENCE AGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A m,nint PER OTH- STATUTE ER E L EACH ACCIDENT E L DISEASE -EA EMPLOYEE IEL DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Elk Creek Mine Permit #1981 - 022 CERTIFICATE HOLDER CANCELLATION _0 F `Q Division Of Reclamation 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 Mining and Safety 1313 Sherman Street Room 215 , (j!l J. Denver CO 80203 USA s+ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD