2017-01-05_GENERAL DOCUMENTS - C1981018

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ACORE® CERTIFICATE OF LIABILITY INSURANCE �.� DATE(MM/DD/YYYY) 12/27/2016 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 Lace Skalick NAME: y y Hays Companies 80 South 8th Street PHCONE(612)333-3323 a/c No: E-MAIL ADDRESS: lskalicky y P @ha scorn anies.com INSURER(S) AFFORDING COVERAGE NAIC# Suite #700 INSURER A Zverest National Insurance Co. 10120 Minneapolis MN 55402 INSURED INSURER B: INSURERC: Deseret Generation & Transmission INSURER D: Email to: mriggs@deseretpower.com INSURER E: 10714 South Jordan Gateway INSURER F: South Jordan UT 84095 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED occurrence $ 2,000,000 PREMISES Ea MED EXP (Any one person) $ 10,000 EN4GL00113-161 12/30/2016 12/30/2017 PERSONAL &ADV INJURY $ 21000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY 7 JECTPRO ❑ LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A STATUTE I ER E L EACH ACCIDENT $ EL DISEASE - EA EMPLOYE $ (Mandatory in NH) IF yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ RricrarvG DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Deserado Mine in Rangely, Colorado (Permit #C-81-018). i! 05 017 DWI$ION OF RECLAMATION MINING AND 3AIrETY CERTIFICATE HOLDER CANCELLATION State of Colorado Division of Reclamation 1313 Sherman Street Room 215 Denver, CO 80203 ACORD 25 (2014/01) INS025 ont4m i 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/EGILMA Z ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD