2016-08-02_GENERAL DOCUMENTS - C1981019

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AC40RO® y CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) 7/28/2016 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 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 Hays Companies NAME CT Lacey Skallcky PHONE (515) 802-3006 Aa No: ADDRESS: Ruan Center, 666 Grand Avenue INSURER(S) AFFORDING COVERAGE NAICX 17th Floor INSURER A:Arch Insurance Company 11150 Des Moines IA 50309 INSURED INSURER B:Chuhb 22667 INSURER C: Elk Ridcre Mining and Reclamation, LLC c/o Tri-State G&T INSURER D • INSURER E' 1100 West 116th Ave INSURER F' Westminster CO 80234 COVERAGES CERTIFICATE NUMBER:2016-2017 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MMIDD/YYY`/ X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS -MADE X 1 OCCUR A O S 100,000 PREMISES (Ea occurrence) EP01004502-00 8/1/2016 8/1/2017 MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ 1,000,000 L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000O PRODUCTS - COMP/OP AGG S 2,000,000 - POLICY PRO FXLOC J I'OTHER Employee Benefits S 1,000,000 COMBINED SINGLE LIMIT S AUTOMOBILE LIABILITY Eat BODILYILY INJURY (Per person) S ANY AUTORECEIVED BODILY INJURY (Per accident) S ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS AUG U 2 2016 er acaden S X UMBRELLA LIAREXOCCUR ®_, - , y _ ^, `BEXCESSLIABCLAIMS-MADE H OCCURRENCE 5 2S,000 000 �AGGR�EGATE S_25L0)�000 "G2gis5160 DEGRETEIJTiOrvS io.000 I 001.�1'��J U/1/2016 8/1/2017 S WORKERS COMPENSATION PER 0TH- ER AND EMPLOYERS' LIABILITYSTATUTE IN Y❑ ANY PROPRIETOR/PARTNER/EXECLJrIVE E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA E L DISEASE - POLICY LIMIT S If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Evidence of Insurance as respects Colowyo Coal Company, L.P. (Permit #C-81019). includes use of Explosives II:111:Le] Colorado Mined Land Land Division 1313 Sherman Street, Denver, CO 80203 ACORD 25 (2014/01) INS025 rnrlann 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Reclamation Mined THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RM 215 AUTHORIZED REPRESENTATIVE James Hays/TJOHNSJZ VT`JBtf-LUl4A.umut,umrv1cN11V1V. NllrryrrwrCaervcu. The ACORD name and logo are registered marks of ACORD