2016-06-13_GENERAL DOCUMENTS - C1983059

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-1 ® 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 222 Lakeview Avenue CONTACT NAME: (A/CNNo Ext): (866) 283-7122 (ACX 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 Mining, LLC INSURER B, American Guarantee & Liability Ins Co 26247 1601 Forum Place INSURER 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: 570062334217 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 INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADEX❑ OCCUR General Li abl i ty 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 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $10,0001 OOO POLICY 1-1PRO-Fx LOC JECT PRODUCTS - COMP/OP AGG $2,000,000 OTHER A AUTOMOBILE LIABILITY BAP 9265950-06 Business Automobile cover 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 HI RED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident B X UMBRELLALIAB X OCCUR AUC926593706 06/01/2016 06/01/2017 EACH OCCURRENCE $25,000,000 EXCESS LL4B CLAIMS -MADE umbrella AGGREGATE $25,000,000 DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNER /'At" PER OTH- STATUTE I IER E L EACH ACCIDENT OFFICER/MEMBER EXCLUDED9 (Mandatory in NH) ❑ If yes, describe under DESrRIPTION OF OPERATIONS below N / A �� 3 N E L DISEASE -EA EMPLOYEE E L DISEASE -POLICY LIMIT 01`gSION OF RECL4 MININGANp A77CW DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Permit number C - 1983-059 Terror Creek Loadout Division of Reclamation, Mining and Safety is included as Additional Insured as required by written contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability, Automobile Liability, and Umbrella Liability policies. 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, Mining AUTHORIZED REPRESENTATIVE and Safety 1313 Sherman Street, Room 215 Denver Co 80203 USA TOd_ifcp c..J��- st`a'a ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD m w c d d 2 0 2 1- 0 0 0 LO O 2 d ltl V d U