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Fn:Penny.Vianzon To:CB Minerals Company LLC - 2019/2020 Renewal Cer (13038328106) 15:53 08/26/19 GMT-07 Pg 4-6 <br /> /EMC <br /> INDURANCB <br /> EMPLOYERS MUTUAL CASUALTY COMPANY POLICY NUMBER: 1D1-52-86---20 <br /> C.B. AIITIEPALS COMPANY LLC EFF DATE: 07/12/19 EXP DATE: 07/12/20 <br /> G E N E R. A L L I A B I L I T Y P 0 L I C Y <br /> D E C L A R A T I O N S <br /> E113ORSEMEIIT SCHEDULE <br /> EDITION <br /> FORM DATE DESCRIPTION/ADDITIONAL INFORMATION PREMIUM <br /> ------------------------------------------------------------------------------ <br /> CG0001 04-13 COMMERCIAL GEN LIABILITY COV FORM <br /> CG0300 01-96 DEDUCTIBLE LIABILITY INSURANCE <br /> APPLICATION OF ENDORSEMENT (LIMITATIONS) : <br /> $500 DEDUCTIBLE APPLES TO PD PER OCCUR <br /> CG2106 05-14 EXCL-ACCESS/DISCL OF CONFID/PERSONAL <br /> CG2146 07-98 EXCL-ABUSE OR MOLESTATION <br /> CG2147 12-07 EXCL-EEPLOYMENT RELATED PRACTICES <br /> CG2150 04-13 AMENDI4ENT/LIQUOR LIABILITY EXXCLUSION <br /> CG2167 12-04 FUNGI OR BACTERIA EXCLUSION <br /> CG2170 01-15 CAP/LOSSES FROM CERT ACTS/TERRORISM <br /> CG2176 01-15 EXCL PUNITIVE DMGS ACTS OF TERRORISM <br /> CG2294 10-01 EXCL-DDIG TO WORK PERFORATED BY SUD <br /> CG^'001A 10-12 GENERAL LIABILITY SCHEDULE <br /> CC37 003 10-13 GL QUICK REFERENCE (OCCURRENCE) <br /> CG''191 08-14 GENERAL LIAB ESSENTIAL EXTENSION <br /> CG_'422 06-00 EXCL INJ/DAMAGE FROM EARTH MOVEMENT <br /> CG'480 10-13 AI-OWN,LESSEE,CONTRACTOR-VICAR LIAB <br /> NAME: <br /> STATE OF COLOR.ADO DIVISION OF <br /> MINERALS AND GEOLOGY <br /> 1313 _;HERMAN ST, ROOM 215 <br /> PROJECT ADDRESS: <br /> COAL RIDGE NO 1 MINE SOUTH OF <br /> THE RIVER EAST OF NORTH EAST <br /> CASTLE, CO 81647 <br /> NAME: <br /> NCIG FINANCIAL, IIIC. <br /> PO BOX 5460 <br /> PLAYA DEL REY CA 90296 <br /> PROJECT ADDRESS: <br /> COAL RIDGE NO 1 MINE SOUTH OF <br /> THE RIVER EAST OF NORTH EAST <br /> CASTLE, C,_) 81647 <br /> ECG-7501 10-13 AI-DESIG PERSON/ORGAN-VICAR LIAB <br /> NA14E/CONCESSIONAIRES/JOB TITLES/ <br /> POT,TTTCAL FNTTTY/ASSOC. OR ORG./FTC. <br /> NCIG FINANCIAL, INC. <br /> PO BOX 1827 <br /> PEBBLE BEACH CA 93953 <br /> STATE OF CCLORADO DIVISION OF <br /> MINERALS AND GEOLOGY <br /> 1313 SHERMAN ST, ROOM 215 <br /> IL0021 09-08 NUCLEAR ENERGY LIAB EXCL/BROAD FORM <br /> IL0125 11-13 COLOR-DO CHANGES - CIVIL UNION <br /> DATE OF ISSUE: 04/15/19 (CONTINUED) <br /> FORM: IL7131A (ED. 04-01) 203 AL 1D15Z96 2001 <br />