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AGENCY CUSTOMER ID: 570000036509 <br />LOC #: <br />A ADDITIONAL REMARKS SCHEDULE <br />Page _ of _ <br />AGENCY <br />Aon Risk Services, inc of Florida <br />NAMEDINSURED <br />Oxbow Energy Solutions LLC <br />POLICY NUMBER <br />see Certificate Number: 570062334231 <br />CARRIER 77777 <br />See Certificate Number: 570062334231 <br />EFFECTIVE DATE <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />Additional Description of Operations / Locations / Vehicles <br />Commercial General Liability covers use of explosives. <br />Division of Minerals & Geology is named as an Additional insured excluding workers' Compensation and <br />Employers' Liability as required by written contract but limited to the operations of the insured under said <br />contract, and always subject to the policy terms, conditions and exclusions. <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />