2020-08-13_GENERAL DOCUMENTS - C1981019

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® F DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/31/2020 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). CONTACT Lacey Skalicky PRODUCER NAME: PHONE 515 802-3006 FAX Hays Companies Inc. A/C No Ext: ( ) A/C,No): Ruan Center,666 Grand Avenue E-MAIL ADDRESS: 17th Floor INSURER(S)AFFORDING COVERAGE NAIC# Des Moines IA 50309 INSURERA: Imperium Insurance Company 35408 INSURED INSURER B: Elk Ridge Mining and Reclamation LLC INSURERC: 1100 West 116th Avenue INSURER D: c/o Tri-State Generation&Transmission INSURER E: Westminster CO 80234 INSURER F: COVERAGES CERTIFICATE NUMBER: 2020-2021 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVITH 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A MNG-IIC-GL-000347-00 08/01/2020 08/01/2021 PERSONAL&ADV INJURY $ 1,000,000 GENTAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT ❑LOC PRODUCTS $POLICY ❑PRO 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A X EXCESS LIAB CLAIMS-MADE MNG-IIC-CX_0000190-00 08/01/2020 08/01/2021 AGGREGATE $ 10,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance as respects Colwyo 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 Board ACCORDANCE WITH THE POLICY PROVISIONS. Division of Reclamation,Minin AUTHORIZED REPRESENTATIVE 1313 Sherman Street,RM 215 Denver CO 80203 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD