2016-08-02_GENERAL DOCUMENTS - C2010089

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A`)RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYV) 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 CONTACT LaceySkalicky Hays Companies (wcNo.Ezt1. (515)802-3006 I(ac,No): Ruan Center, 666 Grand Avenue ADDRESS' 17th Floor INSURERS)AFFORDING COVERAGE NAIC# Des Moines IA 50309 INSURER AArch Insurance Company 11150 INSURED INSURER B:Chubb .22667 Elk Ridge Mining and Reclamation, LLC INSURER C: c/o Tri-State G&T INSURER D• 1100 West 116th Ave INSURER E• Westminster CO 80234 INSURER F• 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 POUCY 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE I X I OCCUR DAMAGE SES(TO(Ea occurrence) cTED PREMISES S 100,000 ZP01004502-00 8/1/2016 8/1/2017 MEDEXP(Anyoneperson) S PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY PRO JECT X LOC PRODUCTS-COMP/OP AGG 5 2,000,000 OTHER Employee Benefits S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 25,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE S 25,000,000 DED I X RETENTION 1V 000 U2$.45160 Dui 8/1/2016 8/1/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVENIA E L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E L DISEASE-EA EMPLOYEE S - If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Colorado Mined Land Reclamation Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division of Reclamation, Mining & Safety ACCORDANCE WITH THE POLICY PROVISIONS. 1313 Sherman Street, RM 215 Denver, CO 80203 AUTHORIZED REPRESENTATIVE James Hays/TJOHNS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(701401(