2016-08-02_GENERAL DOCUMENTS - C2010089 (3)

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ACOR6r CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 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�C E RECEIVED _NAME: Lacey Skalicky Hays Companies _ A/CNN EXt�(515) 802_-3006 �q/c Ruan Center, 666 Grand Avenue E-MAIL ADDRESS: G V 'y AUG] 17th Floor L 20 _ INSURER(S) AFFORDING COVERAGE NAIC # Des Moines IA 5030 INSURERA:Lexington Insurance Compal 19437 INSURED INSURER B :National union on F_ ire_ Ins. Co 194.45 Western Fuels -Colorado, LLC _ INSURERC:_ Email to: rklingler@tristategt.org INSURER D: _ Tri-State G&T; 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 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 LTR TYPE OF INSURANCE WVDPOLICY NUMBER POLICY EFF�OLICY EXP i MM/DDNYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE 1 X-1 OCCUR DAMAGERENTED 100,000 J -1 PREMISESS({Ea occurrence $ 021396066 8/1/2016 8/1/2017 MED EXP (Any one person) $ PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER AGGREGATE 1 $ 2,000,000 X ' PRO- POLICYJECT LOC _GENERAL -� l PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea_acaderto ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS _ AUTOS td BODILY INJURY Per accident) $ ( ) HIRED AUTOS NON -OWNED _ AUTOS PROPERTY DAMAGE $ (Per accident $ X I UMBRELLA LIAB X OCCUR 1 EACH OCCURRENCE _ _ $ _ 25,000,000 EXCESS LIAB CLAIMS -MADE B _ (AGGREGATE $ 25,000,000 DED I X RETENTION$ 10,000 BES4160099 8/1/2016 8/1/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN _ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT_ $ 1 OFFICER/MEMBER EXCLUDED? N / A _ (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / 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. VCR I Irm iA I C 1'1VLLJCIY L;ANI;tLLA I IUN Colorado Mined Land Reclamation Board Division of Reclamation, Mining & Safety 1313 Sherman Street, RM 215 Denver, CO 80203 ACORD 25 (2014/01) INS025 (201401) 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��- © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD