2019-09-13_PERMIT FILE - C1981019A ‎(2)‎

• Permit No: C1981019A
• IBM Index Class Name: Permit File
• Doc Date: 9/13/2019
• Section_Exhibit Name: Exhibit 03 Certificate of Insurance
• Media Type: D
• Archive: Yes

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ACC>R" CERTIFICATE OF LIABILITY INSURANCE DATE 08//0101//22019019 j
_/
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.
H 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 CONT
O TA Lacey Skaficky or Alelandra Chavez Rivas
Hays Companies Inc PHHCNN Eat [phone] Arc No• [phone]
IAI80 S 8th Street E-MAIL ADDRESS: achavezrivas@hayscompanies cam
Suite 700 INSURERS)AFFORDING COVERAGE NAIC#
Minneapolis MN 55402 INSURER A Everest National Insurance Company 10120
INSURED INSURER B ACE Property 8 Casualty Insurance Co 20699x
Elk Ridge Mining and Reclamation LLC INSURER C;
COLOWYO COAL COMPANY LP INSURER D:
1100 West 116th Avenue INSURER E
Westminster CO 80234 INSURER F:
COVERAGES CERTIFICATE NUMBER: 2019-2020 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 POLICY NUMBER MPAMDfYYYY MWOD/YYYY LIMITS
EFF POLICY EXP
LTR INSD WVD
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
AMA E 100,000
CLAIMS-MADE OCCUR PREMISES Ea oau__ $
MED EXP(Any one Person) $ 5,000
A EN4GL00335-191 08/01/2019 08/01/2020 PERSONAL It AOV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
POLICY E]PE� ©L� PRODUCTS-COMP/OP AGG $ 2,000,000
E
OTHER
AUTOMOBILE LIABILITYCOMBINaccdED SINGLE LIMIT $
ANY AUTO BODILY INJURY(Per peraen) $
OWNED SCHEDULED BODILY INJURY(Par accident) $
AUTOSONLY AUTOS
HIRED NON.OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per scadeni
UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 25,000,000
B EXCESS UAB CLAIMS-MADE XOO G28145160 004 08/01/2019 06/01/2020 AGGREGATE $ 25'000'000
DED I X RETENTION$ 10'000 $
WORKERS COMPENSATION PER O -
AND EMPLOYERS'IJABILRYIN
Y STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE [:] N/A E L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED'
(Mandabry In NH) E L DISEASE-EA EMPLOYEE $
Ilyee,describe under
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be atbched d more space is required)
Evidence of Insurance as respects Colowyo Coal Company,L P(Permit#C-81019) Includes use of Explosives
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Colorado Mined Land Reclamation Mined Land Division ACCORDANCE WITH THE POLICY PROVISIONS
1313 Sherman Street,RM 215
AUTHORIZED REPRESENTATIVE
Denver CO 80203
©1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(201[(03) The ACORD name and logo are registered marks of ACORD
Exhibit 3-1 Revision Date: 8/1/19
Revision No.: MR-206