2019-06-04_GENERAL DOCUMENTS - C1981022 (2)

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® 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 Bri ckel l Bay Drive CONTACT NAME: PHONE(866) 283-7122 FAX (800) 363-0105 (AIC. No. Ext): (AIC. No.): E-MAIL ADDRESS: Suite 1100 Miami FL 33131 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich American Ins Co 16535 Oxbow Mi ni nq, LLC 1601 Forum Place INSURER B: INSURER C: Suite 1400 West Palm Beach FL 33401-8101 USA INSURER D: INSURER E: & conditions INSURER F: DAMAGE RENTED $1,000,000 PREMISES Ea occurrence COVERAGES CERTIFICATE NUMBER: 570076444949 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYYI (MM/DDr1rYYYJ LIMITS A X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR SIR applies per policy terns & conditions DAMAGE RENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $4,000,000 PRO- POLICY ❑PRO � 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 X AUTOS ONLY AUTOS HIREDAUTOS X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident EACH OCCURRENCE UMBRELLA LIAB OCCUR 1 AGGREGATE EXCESS LIAR CLAIMS -MADE DED RETENTION JUN 0 4 WORKERS COMPENSATION AND EMPLOYERS' LIABILITYSTATUTE ANY PROPRIETOR / PARTNER / EXECUTIVE Y / N OFF CER/MEMBER (Mandatory n NH)EXCLUDED? ❑NIA DIVISION OFE ONiNGAW W TI N PER OTH- I ER L EACH ACCIDENT E L DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below 7 EL DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Elk Creek Mine Permit #1981 - 022 CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Division Of Reclamation AUTHORIZED REPRESENTATIVE Mining and safety 1313 Sherman Street Room 215 �rJicO Denver CO 80203 USA sLtte�d 7za c/ if�a'�c ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD