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2018-07-31_GENERAL DOCUMENTS - C2010089
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2018-07-31_GENERAL DOCUMENTS - C2010089
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Last modified
8/1/2018 7:43:37 AM
Creation date
8/1/2018 7:11:20 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C2010089
IBM Index Class Name
General Documents
Doc Date
7/31/2018
Doc Name
Certificate of Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
BFB
Media Type
D
Archive
No
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A <br />SR" CERTIFICATE OF LIABILITY INSURANCE <br />FDATE (MM/DDIYYYY) <br />07/24/2018 <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 />CONTACT Tim Johnstad or Lacey Skalicky <br />NAME: <br />Hays Companies <br />PHONE 612-333-3323 FAX 612-373-7270 <br />A/C No Ext): AIC, No <br />E-MAIL t)ohnstad@hayscompanies com <br />ADDRESS: <br />80 S 8th Street <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />Suite 700 <br />INSURERA: Arch Insurance Company 11150 <br />Minneapolis MN 80234 <br />INSURED <br />INSURER B: ACE Property & Casualty Insurance Co 20699 <br />INSURER C: <br />Elk Ridge Mining and Reclamation LLC <br />INSURER D: <br />1100 West 116th Avenue <br />INSURER E: <br />MED EXP (Any one person) $ <br />INSURER F. <br />Westminster CO 80234 <br />COVERAGES CERTIFICATE NUMBER: 2018-2019 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 CONTRACTOR 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 <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MMIDD/YYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,000 <br />CLAIMS -MADE Ix OCCUR <br />DAMAUF TO RENTED 100,000 <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ <br />PERSONAL &ADV INJURY $ 1,000,000 <br />A <br />EP01004502-02 <br />08/01/2018 <br />08/01/2019 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE $ 2,000,000 <br />POLICY ❑JECT PRO ® LOC <br />�!� <br />PRODUCTS-COMP/OPAGG $ 2.000,000 <br />$ <br />OTHER <br />F <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ <br />Ea accident <br />BODILY INJURY (Per person) $ <br />ANYAUTO <br />2°1 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />aur 3 <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />Per acadent <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />On Of ReS$f <br />$ <br />UMBRELLA LIAB <br />[� <br />OCCUR <br />t <br />EACH OCCURRENCE $ 25,000,000 <br />AGGREGATE $ 25,000,000 <br />B <br />EXCESS LIAB <br />CLAIMS -MADE <br />628145160 003 <br />08/01/2018 <br />08/01/2019 <br />DED RETENTION $ 25,000 <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/ N <br />PER OTH- <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVEF-1 <br />OFFICER/MEMBER EXCLUDED <br />N /A <br />E L EACH ACCIDENT $ <br />(Mandatory in NH) <br />E L DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E L DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Evidence of Insurance as respects New Horizon North Mine in Nucla, CO (Permit #C-2010-089) and New Horizon Mine (Permit #C-81-008) <br />Includes explosives <br />l:tK I WIL;AI t MULUtK t+Arvl.tLL.AI IUIV <br />Colorado Mined Land Reclamation Board Division of Reclamation, <br />1313 Sherman Street, RM 215 <br />Denver <br />CO 80203 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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