2018-08-08_GENERAL DOCUMENTS - C1984065

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f /�� CBMINER-01 BMEASE ACORO" CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) �� 07/30/2018 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 License#0757776 CONTACT Betsy Mease NAME: HUB International Insurance Services(COL) PHONE FAX 2742 Crossroads Blvd (A/C,No,Ext),(303)382-5177 (A/C,No):(866)243-0727E-MAIL 43-0727 Grand Junction,CO 81506 n DRIESS:betsy.mease@hubinternational.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Em to ers Mutual Casualty Company 21415 INSURED INSURER B: CB Minerals Company,LLC lj c/o Angela Poulton �s._. (\� INSURER C 8717 Delgany Ave#215 ��G� ��{ INSURER D: Playa Del Rey,CA 90293 V� \�� S1^` INSURER E: \ I 11AMGINSURER F: COVERAGES CERTIFICATE UMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 1X15286 07/12/2018 07/12/2019 DAMAGE TO RENTED PREM300,000 X I E Ea occurrence $ MED EXP(Anyoneperson) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY D JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED L SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ RECEIVED PROPERTY DAMAGE AUTOS ONLY AUUTOS ONLY Per accident $ r� $ UMBRELLA LIAB OCCUR Aub �� ;I�8 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ DIVISION OF RECA AM NON, $ WORKERS COMPENSATION MINING AND SAFETYSTATUTE ER H AND EMPLOYERS'LIABILITY Y I N ANY OFFICER/MEMBER EXCLUDED ECUTIVE ❑ N/A EL EACH ACCIDENT $ (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: DMG Permit#C84065 Coal Ridge No 1 Mine,East of New Castle CO.,South of River. State of Colorado Division of Minerals and Geology and NCIG Financial Inc are additional insureds for General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE State of Colorado THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Division of Minerals and Geology 1313 Sherman St.,Room 215 Denver,CO 80203-2273 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD