2017-12-27_GENERAL DOCUMENTS - C1981018

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O A��1® CERTIFICATE OF LIABILITY INSURANCE DATE /18/2D/YYYY) 12/18/2017 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 CONTACT Tim Johnstad NAME: Hays Companies PHONE (612)333-3323 FAX 612-373-7270 A/C No Ext • AIC, No E-MAIL Scom tohnstad ha anies.com ADDRESS: @ y p 80 South 8th Street INSURER(S) AFFORDING COVERAGE NAIC # Suite #700 INSURER A: Everest National Insurance Company 10120 Minneapolis MN 55402 INSURED INSURER B: INSURER C : Deseret Generation & Transmission INSURER D. 10714 South Jordan Gateway INSURER E: INSURER F: South Jordan UT 84095 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AIJUL INSD bUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE ® OCCUR DAMAGETO PREMISES Ea nte $ 2,000,000 oNcu a MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 2,000,000 A EN4GL00113-171 12/30/2017 12/30/2018 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO- JECT ❑ PRO- ❑ LOC $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS-MADE DED I I RETENTION $ $ WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEElN OFFICER/MEMBER EXCLUDED / A OTH- STATUTE ER EL EACH ACCIDENT $ (Mandatory in NH) EL DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS b=low DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ��1r RECEIVE Re: Deserado Mine in Rangely, Colorado (Permit #C-81-018) DEC 2- NIT Division of &esam yions Mining CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN State of Colorado Division of Reclamation ACCORDANCE WITH THE POLICY PROVISIONS. 1313 Sherman Street Room 215 AUTHORIZED REPRESENTATIVE Denver CO 80203 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD