2016-10-03_PERMIT FILE - C1981008A (2)

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AC4 Rye CERTIFICATE OF LIABILITY INSURANCE D��Ze2o 16 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(les) must be endorsed. If SUBROGATION IS WANED, 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 NAAMT�cT Lacey Skalicky PHONE , (515) 802-3006 1 FAX No. Hays Colapaniea EMAIL ADDRESS: Ruan Center, 666 Grand Avenue 17th Floor INSURERS AFFORDING COVERAGE NAIL e INSURER A Arch Insurance Company 11150 Den Moines IA 50309 INSURED INSURER 8.Ch l 22667 Elk Ridge Ming and Reclamation, LLC INSURER C: INSURER D: c/o Tri-State GiT INSURER E: 1100 West 116th Ave INSURER F: westmiruter 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. NOR T TYPE OF INSURANCEALIDL 1313 Sherman Street, RM 215 POLICY NUMBER POLI Y EFF M POLICY EXP LIMBS $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ®OCCUR PREMI S ocarrenm $ 100,000 MED EYP (Any one peman) $ ZP01004502-00 8/1/2016 8/1/2017 PERSONAL L ADV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PEP' GENERAL AGGREGATE $ 2,000,000 POLICY ❑ JECT ® LOC PPODUCTS-COMPIOPAGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER AUTOMOBILE LIABILITY M a�En SING LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL0IMREDSCHEDULED AUTOS AUTOS BODILY INJURY 01.—do" S PROPERTY DAMAGE $ r HIRED AUTOS NON -OWNED NON AUTOS $UMBRELLA LUB S OCCUR EACH OCCURRENCE S 25,000,000 AGGREGATE $ 25,000,000 B EXCESS LIAR CLAIMS -MADE DED I a I PErENTION$ 10.000 1 $ 028145160 001 8/1/2016 8/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y i N ANY PPOPPIETOPIPAPTNEPIEXECUTIVE PEP TAT E EP E L EACH ACCIDENT $ OFFICEPIMEMBEP EXCLUDED? ❑ NIA E L DISEASE - EA EMPLOYE $ (Mandatory In NH) M yyse daeaibe under DESL�PIPTION OF OPERATIONS bb. E L DISEASE - POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddiBonel Remarks Schedule, may be attached H mom space Is requlmd) 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. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) INR025 rwnnmi ®1988 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Attachment 2.03.9-1 Page 1 Revised: August 2016 (SO -02) 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, boning 6 Safety ACCORDANCE WITH THE POLICY PROVISIONS. 1313 Sherman Street, RM 215 AUTHORIZED REPRESENTATIVE Denver, CO 80203 James Hays/TJOHNS J ACORD 25 (2014/01) INR025 rwnnmi ®1988 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Attachment 2.03.9-1 Page 1 Revised: August 2016 (SO -02)