2019-06-04_GENERAL DOCUMENTS - C1983059 (2)

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�1 ® A o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/31/2019 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 Aon Risk Services, Inc Of Florida 1001 Brickell Bay Drive CONTACT AME: NPHO (A/CNNE o.Ext): (866) 283-7122 jac.No.): (800) 363-0105 E-MAIL ADDRESS: Suite 1100 Miami FL 33131 USA INSURER(S) AFFORDING COVERAGE NAIC # Division Of Reclamation, Mining INSURED INSURERA: Zurich American Ins Co 16535 Oxbow Mi ni nQ, LLC INSURER B: American Guarantee & Liability Ins Co 26247 1601 Forum Place Suite 1400 INSURER C: INSURER D: West Palm Beach FL 33401-8101 USA INSURER E: & conditions INSURER F: DAMAGE TT $1,000,000 PREMISES Croccurrence COVERAGES CERTIFICATE NUMBER: 570076444950 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Division Of Reclamation, Mining GLO AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR 1313 Sherman street, Room 215— Denver Co 80203 USA SIR applies per policy terns & conditions DAMAGE TT $1,000,000 PREMISES Croccurrence MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGATELIMITAPPLIESPER GENERAL AGGREGATE $4,000,000 POLICY ❑ PRO 7 LOC JECT PRODUCTS - COMP/OPAGG $2,000,000 OTHER A AUTOMOBILE LIABILITY BAP 9265950-09 06/01/2019 06/01/2020 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLYAUTOS X HIRED AUTOS X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident B X UMBRELLA LIAB X OCCUR AUC926593709 06/01/2019 06/01/2020 EACH OCCURRENCE $25,000,000 EXCESS LWB CLAIMS -MADE AGGREGATE $25,000,000 DED X RETENTION $10,000E t ED WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNER / EXECUTIVEI' `AI (Y PER OTH- STATUTE I ER E L EACH ACCIDENT OFFICER/MEMIER EXCLUDED ❑ (Mandatory in NH) NIA I,JUN u �019 E L DISEASE -EA EMPLOYEE If yes, descnbe under DESCRIP PION OF OPERATIONS below E L UISEASE-POLICY LIMIT MININGAND og DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) RE: Permit number C - 1983-059 Terror Creek Loadout Division of Reclamation, Mining and Safety is included as Additional Insured as required by written contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability, Automobile Liability, and Umbrella Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE X� POLICY PROVISIONS. Division Of Reclamation, Mining AUTHORIZED REPRESENTATIVE and safety 1313 Sherman street, Room 215— Denver Co 80203 USA a(Jro_fcQ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD