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A� o CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />08/29/2016
<br />I
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Aon Risk Services Southwest, Inc.
<br />Houston TX Office
<br />CONTACT
<br />NAME:
<br />(A/C.NNo. Ext): (866) 283-7122 ((A No.): (800) 363-0105
<br />E-MAIL
<br />ADDRESS:
<br />5555 San Felipe
<br />Suite 1500
<br />Houston TX 77056 USA
<br />GLO 5 51 41 7
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A: Zurich American Ins Co 16535
<br />GCC EnerOV, LLC
<br />INSURER B: Zurich American Ins Co Of Illinois 27855
<br />6473 County Road 120
<br />Hesperus CO 81326 USA
<br />INSURER C: American Zurich Ins Co 40142
<br />INSURER D: Liberty Insurance Underwriters, Inc. 19917
<br />INSURER E:
<br />DAMAGE TO RENTED $1,000,000
<br />PREMISES Ea occurrence
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570063464983 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 />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/
<br />POLICY EXP
<br />MM/DD/
<br />LIMITS
<br />C
<br />X COMMERCIAL GENERAL LIABILITY
<br />GLO 5 51 41 7
<br />1 1
<br />7
<br />EACH OCCURRENCE $2,000,000
<br />CLAIMS-MADEX❑ OCCUR
<br />DAMAGE TO RENTED $1,000,000
<br />PREMISES Ea occurrence
<br />MED EXP (Any one person) $10,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEML AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $4,000,000
<br />X POLICY [—]PRO ❑ LOC
<br />JECT
<br />PRODUCTS - COMP/OP AGG $4,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />BAP6551242-07
<br />09/01/201609/01/2017
<br />COMBINED SINGLE LIMIT $1,000,000
<br />Ea accident
<br />BODILY INJURY ( Per person)
<br />X ANY AUTO
<br />BODILY INJURY (Per accident)
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED AUTOS NON -OWNED
<br />ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />D
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />100005937506
<br />09/01/2016
<br />09/01/2017
<br />EACH OCCURRENCE $25,000,000
<br />LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $25,000,000
<br />EEXCESS
<br />DED RETENTION
<br />Products/Completed O $25,000,000
<br />B
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/ PARTNER / EXECUTIVE
<br />N
<br />wc655124007
<br />09/01/2016
<br />09/01/2017X
<br />PER I OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $2,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />E.L. DISEASE -EA EMPLOYEE $2,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<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 />CERTIFICATE HOLDER
<br />CANCELLATION
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />No
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />Colorado Division of Reclamation,
<br />AUTHORIZED REPRESENTATIVE
<br />Mining & Safety
<br />1313 Sherman Street, Room 215
<br />Denver Co 80203 USA
<br />�7 c�J� J.,
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />No
<br />
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