2016-06-13_GENERAL DOCUMENTS - C1983059 (2)

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A o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/02/2016 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 222 Lakeview Avenue CONTACT NAME: (JC NN . Ext): 1866) 283-7122 F� 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 Energv Solutions LLC INSURER B: American Guarantee & Liability Ins CO 26247 1601 Forum Place INSURER C: Suite 1400 INSURER D: West Palm Beach FL 33401-8101 USA INSURER E: INSURER F MED EXP (Any one person) $10,000 COVERAGES CERTIFICATE NUMBER: 570062334270 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITYGLO EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR SIR applies per policy terns & conditions DAMAGE TO RENTED $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. GENERAL AGGREGATE $10,000,000 POLICY ❑ PRO LOC JECT PRODUCTS-COMP/OP AGG $2,000,000 OTHER A AUTOMOBILE LIABILITY BAP 9265950-06 06/01/2016 06/01/2017 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident B X UMBRELLA LIAB X OCCUR AUC926593706 6/01/2016 06/01/2017 EACH OCCURRENCE $25,000,000 EXCESS LIAB CLAIMS -MADE A �'R� AGGREGATE $25,000,000 DED RETENTION AllowNNNwww "" WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN �^ `' 11J1 PER OTH- STATUTE ER EL EACH ACCIDENT ANY PROPRIETOR / PARTNER / EXECUTIVE J V� OFFICER/MEMBER EXCLUDED' ❑ N I A E.L DISEASE -EA EMPLOYEE (Mandatory in NH) 0►,1 If yes, describe under DESCRIPTION OF OPERATIONS below � N QF REC i``1I F- L DISEASE -POLICY LIMIT MINING DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Terror Creek LLC C-1983-059 Division of Minerals & Geology is included as an Additional Insured as required by written contract but limited to the operations of the Insured under said contract, and always subject to the policy terms, conditions and exclusions. The General policy evidenced herein covers use of explosives. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Division Of Minerals & Geology AUTHORIZED REPRESENTATIVE 1313 Sherman Street Room 215 Denver CO 80203 USA eXXNa/tea 7,TOdkn eJ(! e/�1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD