2016-08-29_PERMIT FILE - C1981035A (46)

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A CERTIFICATE OF LIABILITY INSURANCE DA a(o�,syYY' 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 endomement(s). PRODUCER Aon Risk Services southwest, Inc. Houston TX Office CONTACT NPHONE AME. (A1C. No. Ext): (866) 283-7122 FAX No.I: (800) 363-0105 E -MAH. ADDRESS: 5555 San Felipe suite 1500 INSURERS) AFFORDING COVERAGE MAIC Houston TX 77056 USA INSURED INSURER A: American Zurich ins Co 40142 GCC Energy. LLC 6473 County Road 120 Hesperus CO 81326 USA INSURER B: Zurich American ins Co 16535 INSURER C: Liberty Insurance Underwriters, Inc. 19917 INSURER D: PRODUCTS - COMP/OP AGG $4,000, FOO INSURER E: B MSURER F: COVERAGES CERTIFICATE NUMBER: 570059161954 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. Limits shown are as requested LTR INSR TYPE OF INSURANCE AD INS B yyyp POLICY NUMBER MPOLICYEXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR GLO EACH OCCURRENCE $2,000,000 IYAMAGF- TO RENTED PREMISES Ea coeunence $l, 000, 000 MED EXP (Arty one person) $10,000 PERSONAL a ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY ❑ SECT ❑LOC OTHER: GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $4,000, FOO B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS HIRED AUTOS A� ED $1000 Cor Dad $1000 Comp Dad BAP 6551242-06 09/01/2015 09/01/2016 COMBINED SINGLE LIMIT $1,000,000 accident) BODILY INJURY ( Per Penson) BODILY INJURY (Per accident) PROPEEDAMAGE C x UMBREUALIABx EXCESS LIAB OCCUR CLAIMS -MADE 100005937505 09/017201S 09/01/2016 EACH OCCURRENCE 25,000,000 AGGREGATE $25,000,000 DED I RETENTION ProducfslCompleted0 $25,000,000 B WORICERS COMPENSATION AND EMPLOYERS• LIABILITY YIN ANY PROPRIETOR I PARTNER I EXECUTIVE N OFFICERIMEMBER EXCLUDED? N (Mandatory in NII Idescribe under DESCRIPTION OF OPERATIONS below NIA WC6SS124006 697-6172151109/03. 201PER DTH X STATUTE I 1E1 E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE S2,000,000 E.L. DISEASE -POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedsde, may be attached I mon space Is required) RE: DSM Permit CO -0106 and CDRMS Permit co -1981-035. Marc and Julie Crawford are included as Additional insured in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE 1MTH THE POLICY PROVISIONS. Marc and Julie Crawford AUTHORIZED REPRESENTATIVE 2323 county Road 121 Hesperus CO 81326 USA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD