2016-09-22_REVISION - C2010089 - Laserfiche WebLink

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CERTIFICATE OF LIABILITY INSURANCE DATE {MM1VDDII'YYY] 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), Al REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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). PRODLCER CONTACT Lacer Skalicky Hays Companies PKONE (515)802-3006 IFA% WC,Np.Enl: .. ..._ IArC, No): ___... Ruan Center, 666 Grand Avenue E-MAIL ADDRESS: 17th Floor INSURER(S) AFFORDING COVERAGE NMC:I msuRERAILrch Insurance Cozpany insa DBS MoineS IA 50309 INSURED INSURER B --Chubb 22667 INSURER C: Elk Ridge Mining and Reclamation, LLC INSURER D: CIO Tri-State G&T 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. ILT R TYPEOF 1RSURANCE ADDL PDLPCY NUMBEST MMIDDIIYYYY MPO EYYY LIMITS S COMMERCIAL GENERAL LIAIKUTY EACH OCCURRENCE t 1,000,000 A CWMS-MADE �% OCCUR Pp S DAMAGETOPENTED 100, 000 r NED EXP (Any one s 6Pa10045D2-00 8/1/2016 5/1/2017 PERSONAL&ADV INJURY $ 1,000,000 DEVIL AGG PEGATE LIMIT APPLIES PEP' GENERAL AGGREGATE S 2,000,000 POLICY ❑ JPECT [il LOC PP.ODIICTS- COMPIOP AGG S 2,000,000 Emgayae BeeeRffi S 1,000,900 OTHER: ALMOMOBILE LIABILITY OMBINEP SINGLE U 5 fEa—d-t BODILY INJNPY (Per parson} S ANY ALTO ALL OMED SCHEDULED AUTOS AUTOS BODILY INJURY IPS acdden0 5 PROPERTY DAMAGE S N0NoVVNE0 HIRED RUr05 AUTOS 5 $ UMBRELLA LIAR $ OCCUR EACH OpCUPPENCE $ 25,000,000 AGGP€GATE 5 ZS 000 OOD EXCESS LIAB CIAI..DE DED I g PETE DhIS 10.000 s 628165160 001 8/1/20115 8/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIAB]LRY YIN PFP O TATUTE ER E.L. EACH ACCIDFJ'R S ANY PPOPPIETOPIPAPTNEIRMEXECLITiVE L OFFICEPIMEMBEP EXCLUDED? N! A E.L. DISEASE • EA EMPLOYE S (Mandmory in NH) IIes, deaa0e under D6CPIPTION OF OPEPATIONS Ib k- EL DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Add Iti—P Remarks Schedule, may be snached if more epics Is required) Evidence of insurance as respects New Horizon Horth mine in Nucla, CO (Permit #C-2010-089) and New Horizon Nine (Permit #C-81-008). Includes explosives. 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 MATH THE POLICY PROVISIONS. 1313 Sherman Street, RM 215 Denver, CO 80203 AU1140RI2EDREPRESENTAT11E James Hays/TUGHNS 01988-2014 ACORD CORPORATION. All rights reserve) ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Section 2.03 Page 2 September 2016