2016-08-02_GENERAL DOCUMENTS - C1981019 (3)

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�A ICC>RO® �./ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYV) 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 CONTACT LaceySkallcky NAME. PHONE (515)802-3006 AfC. No Ext) ac No: ADDRESS: Ruan Center, 666 Grand Avenue INSURERS AFFORDING COVERAGE NAIC # 17th Floor 1 INSURER AArch Insurance Co an 11150 Des Moines IA 50309 INSURED I INSURER B :Chubb 22667 INSURERC: Elk Ridge Mining and Reclamation, LLC C/o Tri—State G&T INSURER D' INSURER E' 1100 West 116th Ave INSURER F' Westminster CO 80234 rnvGDAr-Gc CERTIFICATE PJIIMRFR-2016-2017 REVISION NUMBER: v 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 ADDLSUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A ETO R E $ 100 , 000 PREMISES (Ea occurrence) A CLAIMS -MADE X OCCUR [_X_1 EP01004502-00 8/1/2016 8/1/2017 MED EXP (Any one person) $ PERSONAL & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG 5 2,000,000 POLICY -] PRC � LOC JECT Employee Benefits S 1,000,000 OTHER AUTOMOBILE LIABILITY ANY AUTORECEIVED COMBINED SINGLE LIMIT $ Ea accident_ BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NO OWNED HIRED AUTOS AUTOS AUG U 2 2016 PROPERTY DAMAGE eracaden S S B I X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE rc�I�/r; = , ;- ,.-„ (-kMATI ji...u,4.�rtiw IG28i45160 001 N 1 8/1/2016 8/1/2017 EACH OCCURRENCE S 25,000,000 AGGREGATE S 25 000 000 $ -i .. DED I „ IRETEUTiOrv$ iu,OGO WORKERS COMPENSATION AND EMPLOYERS' LIABILITY VIN ANY PROPRIETOR/PARTNERIEXECUTIVE PER OTH- STATUTE ER L EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE S OFFICER/MEMBER EXCLUDED F—]E (Mandatory in NH) NIA E L DISEASE -POLICY LIMIT S If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Evidence of Insurance as respects Colowyo Coal Company, L.P. (Permit #C-81019). Includes use of Explosives Colorado Mined Land Land Division 1313 Sherman Street, Denver, CO 80203 ACORD 25 (2014/01) INS025 (?01401) 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 ames Hays/TJOHNS w I tlao-LU 14 mt.vmu %iURr%Jr%M I wrv. nn r rani- 1-1 rcu. The ACORD name and logo are registered marks of ACORD