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'``# �® CERTIFICATE OF LIABILITY INSURANCE
<br />DA oe01'� "'
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />Aon Risk Services Southwest, inc.
<br />Houston TX Office
<br />(866) 283-7122FAX (800) 363-0105
<br />A1C. No. �$ AIC. No.:
<br />E4AIL
<br />ADDRESS:
<br />5555 San Felipe
<br />Suite 1500
<br />INSURERIS) AFFORDING COVERAGE NAIL s
<br />Houston TX 77056 USA
<br />INSURED
<br />INSURERA: American Zurich ins Co 40142
<br />GCC Energy, LLC
<br />6473 County Road 120
<br />Hesperus Co 81326 USA
<br />INSURERS: Zurich American Ins Co 16535
<br />INSURER C: Liberty insurance Underwriters, Inc. 19917
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />DAMAGE TO RERMTF PREMISES occunence $1,000,000
<br />COVERAGES CERTIFICATE NUMBER: 570059161841 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />AM
<br />I
<br />POLICY NUMBER
<br />POLICY EFF
<br />POUCYEXP
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />GL0655124106
<br />09/01/2015
<br />09/01/2016
<br />EACH OCCURRENCE $2,000,000
<br />CLAIMSMADE X❑OCCUR
<br />DAMAGE TO RERMTF PREMISES occunence $1,000,000
<br />MED EXP (Any one person) $10,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER-
<br />GENERAL AGGREGATE S4 , 000, 000
<br />X POLICY ❑ JEO - F-]LOC
<br />PRODUCTS -COMP/OP AGG $4 , 000 , 000
<br />OTHER
<br />B
<br />AUTOMOB mLIABILITY
<br />BAP 6551242-06
<br />09/01/2015
<br />09/01/2016
<br />COMBINED SINGLE LIMIT $1,000,000
<br />e accident)
<br />BODILY INJURY ( Per person)
<br />X ANY AUTO
<br />BODILY INJURY (Per accident)
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />acddent
<br />$1000 Coll Dad $11100 Comp Ded
<br />C
<br />x
<br />UMBRELLA LIAB
<br />x
<br />OCCUR
<br />100005937505
<br />9/01/2015
<br />09/01/2016
<br />EACH OCCURRENCE $25,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $25,000,000
<br />DED RETENTION
<br />Products/Completed O $25,000,000
<br />e
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABNJTY Y / N
<br />ANY PROPRIETOR / PARTNER / EXECUTIVE
<br />OFFICEMMEMBER EXCLUDED? N
<br />(Mandatory in *9
<br />N/A
<br />WC655124006
<br />09/01/2015
<br />-097F172 0-16
<br />X I PER OT}F
<br />STATL TE
<br />EJ- EACH ACCIDENT $2,000,000
<br />E.L DISEASE -EA EMPLOYEE $2,000,000
<br />If yes, desoibe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L DISEASE -POLICY LIMIT $2,000,000 .
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached M more Waco is reWrad) ,
<br />RE: OSM Permit CO -0106, CDRMS Permit CO -1981-035. Colorado Division of Reclamation, Mining & Safety is included as Additional
<br />insured in accordance with the policy provisions of the General Liability policy. ,
<br />I
<br />CERTIFICATE HOLDER CANCELLATION I
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />Colorado Division Of Reclamation, AUTHORIZED REPRESENTATIVE
<br />Mining & Safety
<br />1313 Sherman Street, Room 215 `��x _��1 ��
<br />Denver Co 80203 USA nor
<br />071988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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