2017-06-09_GENERAL DOCUMENTS - C1981020

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ACC>RO` CERTIFICATE OF LIABILITY INSURANCE kill 6/1/2018 F DATE(MM/DD/YYYY) 5/31/2017 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 have ADDITIONAL INSURED provisions or 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 Lockton Companies Three City Place Drive, Suite 900 St. Louis MO 63141-7081 (314) 432-0500 RECEIVED CONTACT NAME: A/C No Ext): A/C No): E-MAIL ADDRESS: AFFORDING COVERAGE NAIC # A : National Union Fire Ins Co Pitts. PA 19445 _INSURER INSURED Rhino Resource Partners LP 1340392 CAM Mining LLC PO Box 1169 JUN 0 9 2017 Pikeville KY 41502 v Division of Reclama$OIt1, INSURER B: Lexington Insurance Company 19437 INSURER C : INSURER D: INSURER E : INSURER F COVERAGES RNTRF, CERTIFICAf1PWH*9E'9: 1 f 291473 REVISION NUMBER: XXXXXXX 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR N N 3261614 6/1/2017 6/1/2018 EACH OCCURRENCE 2,000,000 DAMAGE TO RENTED 2,000,000 PREMISES Ea occurrence MED EXP (Any oneperson) 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY❑ JE� [X LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO AUTOS ONLY SCHEDULED AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY N N 3244251 6/1/2017 6/1/2018 Ee aBade ltSINGLE LIMIT $ 2,000, 000 BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident $ XXXXXXX PROPERTY DAMAGE $ XXXXXXX Per accident $ XXXXXXX B X UMBRELLA LIABX EXCESS LIAB OCCUR CLAIMS -MADE N N 013136615 6/1/2017 6/1/2018 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 51000,000 DED I I RETENTION $ Prod Comp Ops $ 51000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE F1N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) descnbe under DIf ESCRIPTION OF OPERATIONS below / A NOT APPLICABLE I STATUTE ER VVV EL EACH ACCIDENT $ XXXXXXX TV E L DISEASE - EA EMPLOYEE `XXXXXXX E L DISEASE - POLICY LIMIT XXXXXXX DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: MUNGER CANYON MINE, DRMS PERMIT 1981-020 CERTIFICATE HOLDER 11291473 DIVISION OF RECLAMATION MINING AND SAFETY 1313 SHERMAN STREET ROOM 215 DENVER CO 80203 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATIVE n► ACORD 25 (2016/03) ©1988_2D4nCORD C07W0RA`M0N. All rights reserved The ACORD name and logo are registered marks of ACORD