2017-08-07_GENERAL DOCUMENTS - C1981019

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ACORO® AC� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F7/31/2017 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 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 Hays Companies 80 S 8th Street Suite 700 Minneapolis MN 55402 CONTACT Tim JOhnstad NAME: A/CONN Ext): (612) 333-3323 ac No : 612-373-7270 E-MAIL ohnstad@ha scompanies.com ADDRESS: hays INSURER(S) AFFORDING COVERAGE NAIC # INSURERAArch Insurance Company 11150 INSURED Elk Ridge Mining and Reclamation, LLC 1100 West 116th Ave Westminster CO 80234 INSURER B ACE Property & Casualty Ins CO 20699 INSURER C: INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:2017-2018 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 IN SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED 100 , 000 PREMISES Ea occurrence $ i MED EXP (Any one person) $ EP01004502-01 8/1/2017 8/1/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY El JECTPRO [X]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) S PROPERTY DAMAGE NON -OWNED HIRED AUTOS AUTOS S LPeracadent) _ I Is X UMBRELLA LIAB _X OCCUR EACH OCCURRENCE $ 25, 000, 000 AGGREGATE S 25,000,_000 B EXCESS LIAB CLAIMS -MADE DED X RETENTIONS 25,000 $ G28145160 002 8/1/2017 8/1/2018 WORKERS COMPENSATIONOTH- AND EMPLOYERS' LIABILITY Y / N STATUTE _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED?�_� N/A -- - - '_-- -- -- (Mandatory in NH) DISEASE - EA EMPLOYEE If yes describe under DESCRIPTION OF OPERATIONS below _EL EL DISEASE -POLICY LIMIT S � I I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION Colorado Mined Land Reclamation Board Division of Reclamation, Mining & Safety 1313 Sherman Street, RM 215 Denver, CO 80203 ACORD 25 (2014/01) INS025 r?menu 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/TJOHNS f� © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD