2019-09-13_GENERAL DOCUMENTS - C1981035

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DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F 08/30/2019 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 2 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'DO Aon Risk Services southwest, Inc. PHONEFAX Houston TX Office (A/C.No.Ext): (866) 283-7122 (plc.No.): (800) 363-0105 5555 San Felipe E-MAIL p suite 1500 ADDRESS: _ Houston TX 77056 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Zurich American Ins CO 16535 GCC Enerqv. LLC INSURER B: Zurich American Ins Co of Illinois 27855 6473 County Road 120 Hesperus CO 81326 USA INSURER C: Liberty insurance Underwriters, Inc. 19917 INSURER D: American Guarantee & Liability Ins Co 26247 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570078112542 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/YYYY MWDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADE — OCCUR DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 N GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $4,000,000 X POLICY ❑PRO-- ❑LOC PRODUCTS-COMP/OP AGG $4,000,000 co JECTO OTHER o A BAP 6551242-10 09/01/201909/01/2020 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) .0. AUTOS ONLY AUTOS HIREDAUTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident)ts= 1r d C UMBRELLA LAB OCCUR 100005937509 09/01/2019 09/01/2020 EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE occurence Basis AGGREGATE $10,000,000 X DED RETENTION B WORKERS COMPENSATION AND WC655124010 09/01/2019 09/01/2020 X PER OTH- EMPLOYERS'LIABILITY STATUTE ER Y ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ EL EACH ACCIDENT $2,000,000 N/A OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) E L DISEASE-EA EMPLOYEE $2,000,000 If yes,descnbe under E L DISEASE-POLICY LIMIT $2,000,000— DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: OSM Permit CO-0106, CDRMS Permit CO-1981-035. Colorado Division of Reclamation, Mining & Safety is included as Additional Insured in accordance with the policy provisions of the General Liability policy. 9,11 EcE1�E® R � 19 CERTIFICATE HOLDER CANCELLATION C G p ��/ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE N® Ct r EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE M�NIN R SAS POLICY PROVISIONS. Colorado Division Of Reclamation, AUTHORIZED REPRESENTATIVE Mining & Safety 1313 Sherman Street, Room 215 �y c ?�.�01C cJsttYaaQ r�LlatOG��a Denver Co 80203 USA e fj4'oY/n ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD