2016-06-13_GENERAL DOCUMENTS - C1981022

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,4� o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F 05/26/2016 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: (A/CNNo.Ext): (866) 283-7122 (aC No): (800) 363-0105 E-MAIL Suite 510 west Palm Beach FL 33401 USA ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # A INSURED INSURER A: Zurich American Ins Co 16535 Oxbow Mini nq , LLC INSURER B: 1601 Forum Place INSURER C: Suite 1400 INSURER D: west Palm Beach FL 33401-8101 USA INSURER E: INSURER F: General Liablity SIR applies per policy terns COVERAGES CERTIFICATE NUMBER: 570062221986 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 INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MWDD POLICY MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADEX❑ OCCUR General Liablity SIR applies per policy terns & conditions DAMA ET EN nce $1,000,000 PREMISES Ea occurre MED EXP (Any one person) $10,000 ro N 0 o PERSONAL &ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER POLICY ❑ PE ❑X LOC CT OTHER GENERAL AGGREGATE $10,000,000 PRODUCTS -COMP/OP AGG $2,000,000 A AUTOMOBILE LIABILITY BAP 9265950-05 Business Automobile cover 06/01/2015 06/01/2016 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) X ANY AUTO C Z BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY 'i .d+ w d PROPERTY DAMAGE Per accident UMBRELLA LIAB OCCURpn EACH OCCURRENCE V AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION n WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N J STATUTE ETH EL EACH ACCIDENT ANY PROPRIETOR/ PARTNER/ EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED' NIA � TION EL DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS beanE S)QN OF RE NamrTy -A L DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Elk Creek Mine Permit #1981 - 022 C� Y F - 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 Reclamation AUTHORIZED REPRESENTATIVE Mining and safety - Sherman Street Room 215 Denver )�Dicll cJ��i t!!la Denver Co 80203 USA Q �. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD