2018-11-06_GENERAL DOCUMENTS - C1981010

• Permit No: C1981010
• IBM Index Class Name: General Documents
• Doc Date: 11/6/2018
• Doc Name: Certificate of Insurance
• To: DRMS
• Email Name: RAR
• Media Type: D
• Archive: No

ACORO® DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 10/30/2018
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 CONTACT
MARSH USA INC NAME:
PHONE FAX
122517TH STREET,SUITE 1300 AIC,No):
DENVER,CO 80202-5534 E-MAIL
Attn:[e-mail] I FAX [phone] ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
CN103135850-00125-ALL-18-19 INSURER A:Federal Insurance Company 20281
INSURED INSURER 13:N/A N/A
TRAPPER MINING INC
PO BOX 187 INSURER C:ACE Property And Casualty Ins Co 20699
CRAIG,CO 81626 INSURER D:
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: SEA-003351588413 REVISION NUMBER: 7
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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
A X COMMERCIAL GENERAL LIABILITY 35907412 10/01/2017 01/01/2019 EACH OCCURRENCE $ 1,000,000
GET—
CLAIMS-MADE Fx_1 OCCUR PREMISES(EaEoccurrence) $ 1,000,000
MED EXP(Any one person) $ 10,000
PERSONAL 8 ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
X POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
OTHER $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
r $
X UMBRELLA LIAB X OCCUR X00 G27908755 003 10/01/2017 01/01/2019 EACH OCCURRENCE $ 1,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000
DED I X I RETENTION$25,000 $
WORKERS COMPENSATION
PEROTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ❑N N I A
(Mandatory in NH) EL DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $
I.-T 1 F.L.
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
RE: PERMIT#C-81-010
POLICY INCLUDES COVERAGE FOR PROPERTY DAMAGE AND PERSONAL INJURY RESULTING FROM THE USE OF EXPLOSIVES NOV 0 6 2018
Division of Reclamation,
Mining&Safety
CERTIFICATE HOLDER CANCELLATION
COLORADO DIVISION OF RECLAMATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
AND SAFETY DEPARTMENT OF NATURAL RESOURCES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1313 SHERMAN STREET-ROOM 215 ACCORDANCE WITH THE POLICY PROVISIONS.
DENVER,CO 80203
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Jon Lindstrom ,_ y >
©1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD