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Fm:Penny.Vianzon To:CB Minerals Company LLC - 2019/2020 Renewal Cer (13038328106) 15:53 08/26/19 GMT-07 P9 3-6 --•■"MON CBMIN ER-01 PVIANZON AG'ORU� DATE IMMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE F8/26/2019 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 License#0757776 UJJkCT Betsy Mease HUB International Insurance Services(COL) PHONE 2742 Crossroads Blvd IAIC,No,Ext):(303 Fax )382-5177 IA/c,No):(866)243-0727 Grand Junction,CO 81506 betsy.measeLM—hubinternational.com INSURERS)AFFORDING COVERAGE NAtC9 INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER B: CB Minerals Company,LLC INSURERC: c/o Angela Poulton 8717 Delgany Ave#215 INSURER D: Playa Del Rey,CA 90293 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTOWHICH 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 LTR INSD MMIDDIYYYY MM! YY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR iX15286 7/1212019 7/1212020 DMAGE TO RENTED g0 ,000 X PREMISES Ea occurrence $ MED EXP An one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE $ 2,000,000 POLICY Elipm LOC PRODUCTS-COMPIOPAGG $ 2,000'000 OTHER $ AUTOMOBILE LIABILITY COMBENED SINGLE LIMIT ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED A�URTEOpS ONLY AUTOS BODILY Ep BBRODILY INJURY Per accident $ AUTOS ONLY ARTO1 ONLY (Per PROPERTY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB ki CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I JER OFCERIEEXCLUETE�TI� EL EACH ACCIDENT $RIMEMB DD NIA IMandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached if more apace is required) Project: DMG Permit#C84065 Coal Ridge No i 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(2016103) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD