2020-01-13_GENERAL DOCUMENTS - C1981010

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i— 1 ® AC40J " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/04/2021 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 MARSH USA INC 122517TH STREET, SUITE 1300 DENVER, CO 80202-5534 Attn Denver.CertRequest@marsh com / FAX 212-948-4381 CONTACT NAME: PHONE x A/C No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Imperlum Insurance Company 35408 CN103135850-STAND-GAWU-20- INSURED TRAPPER MINING INC INSURER B : N/A N/A PO BOX 187 INSURER C : INSURER D : CRAIG, CO 81626 INSURER E : ��A INSURER F : enVFaenFc CFRTIFICATF NIIMRFR- SEA-003351588-48 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 IN RI LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MNGIICGL000073500 01/01/2021 01/01/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR PREM SET Ea olccur RENTED $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO- ❑ LOC JECT $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident Is BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per accident $ X UMBRELLA LIAB X OCCUR MNGIICCX000039900 01/01/2021 01/01/2022 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION s25,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE PER OTH- STAT UTE ER EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ OFFICER/MEMBEREXCLUDED? ❑ (Mandatory in NH) N / A EL DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE PERMIT#C-81-010 POLICY INCLUDES COVERAGE FOR PROPERTY DAMAGE AND PERSONAL INJURY RESULTING FROM THE USE OF EXPLOSIVES i"COTICICATR ufll nGR CANCELLATION COLORADO DIVISION OF RECLAMATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AND SAFETY DEPARTMENT OF NATURAL RESOURCES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1313 SHERMAN STREET - ROOM 215 ACCORDANCE WITH THE POLICY PROVISIONS. DENVER, CO 80203 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Jon Lindstrom V 19t1S-ZU1b At;UKU k;UKYVKA I IVN. All rlgnrs reserve0. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD