2016-08-02_GENERAL DOCUMENTS - C1981019

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AC40R�® «v CERTIFICATE OF LIABILITY INSURANCE ' 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 Ruan Center, 666 Grand Avenue CONTACT Lace Skali NAME. y cky PHONE (515) 802-3006 FAc No: -MAIL ADDRESS INSURERS AFFORDING COVERAGE NAIC # 17th Floor INSURER AArch Insurance Company 11150 Des Moines IA 50309 INSURED INSURER B :Chubb 22667 INSURER C: Elk Ridge Mining and Reclamation, LLC INSURER D: C/o Tri-State G&T INSURER E • 1100 West 116th Ave 1 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 LTR TYPE OF INSURANCE DL SU POLICY NUMBER MM/DDNYYYFY POLI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A � CLAIMS -MADE OCCUR I � I A A $ 100,000 PREMISES (Ea occurrence) EP01004502-00 8/1/2016 8/1/2017 MED EXP (Any one person) S PERSONAL& ADV INJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG S 2 , 000 , 000 POLICY 7 PRO FX LOC JECT Employee Benefits S 1,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) S ANY AUTO BODILY INJURY (Per accident) S ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ r acaden $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 25,000,000 AGGREGATE S 25,000,000 B EXCESS LIAB CLAIMS -MADE DEG 1 X I RETENTION$ 10,000 $ 02:.:45160 03! 8Ji/2016 8/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E L. EACH ACCIDENT $ E L DISEASE - EA EMPLOYE S OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E L DISEASE -POLICY LIMIT S If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Evidence of insurance as respects New Horizon North Mine in Nucla, CO (Permit #C-2010-089) and New Horizon Mine (Permit #C-81-008). Includes explosives. I:Lei III 113:/ Colorado Mined Land Reclamation Board Division of Reclamation, Mining & Safety 1313 Sherman Street, RM 215 Denver, CO 80203 ACORD 25 (2014101) IN S025 on1401) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE James Hays/TJOHNS�Z—�` D 1988-2014 AGUKU GUKFUKA I IUN. All rtgnis reserves. The ACORD name and logo are registered marks of ACORD