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ClknW.1114209 CARBORIV <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE p.wo+Yrrr) <br /> 11/19r1o2o <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER <br /> IMPORTANT:N the certiflcaia holder is an ADDITIONAL INSURED,the poley(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> N SUBROGATION IS WAIVED,subject to the lens and conditions of the policy,certain poldes may require an endorsement A statement on <br /> this certificate does not confer any rights to the certificate holder In lieu of such orMoresmerRt(a)- <br /> PRooucER Wuy Joyce Denton <br /> USI Insurance Services,LLC 8593716919 <br /> No): 8583176939 <br /> 220 Lexington Green Circle Ea1A1L <br /> Suite 410 •joyNx,dentolt�i.com <br /> Lexington,KY 40503 AFFORoallo NAIcs <br /> I A:hnperium Insurance Company 354M <br /> SOURED IrsURER a:Great Midwest Insurance Company 18694 <br /> ARC McClane Canyon,LLC I+ ftm e:Kenauky Wnpioyers•Numal Insurance 10320 <br /> S6900 Sinfleld Road <br /> Hopedale,OH 43976 I D <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> TYPE OF INSURANCEPOtJCY NUMBERFxP UNITS <br /> A X COMMERCIAL GENERAL LIABILITY MNGIICGL0000231 OW212020 06/02/2021 EActioccuRRENcE $1000 000 <br /> CLAIMS-MADE ❑X OCCUR MTEM roe $100 000 <br /> X BI1PD Ded:10000 MED EXP(Any one parson) $5 000 <br /> PERSONAL R ADV MLAIRY $1 000 000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 <br /> POLICY �JECT ❑Loc PRODUCTS-carlProP AGG s2,000,000 <br /> OTHER $ <br /> A AUTOMOBILE LIABILITY MNGHCCA0000162 2/2020 06/02/2021 �dE,D,sSI�E LIMIT <br /> ANY AUTO BODILY INAJRY(Per person) s <br /> F;;-,71 SCM <br /> ONLY <br /> DULED BODILY MUURY(Par aoddeM) $ <br /> N <br /> ONLY X NON-OWNEDPROPERTY DAMAGE _ <br /> AUTOS ONLY 110waocklenil <br /> $ <br /> A UMBREw►W'a OCCUR UNGIICCXOOOO137 06102r2M 06102/2021 EAcH OCCURRENCE $5 000 000 <br /> X occEss LIAe X CwMSMAM AGGREGATE s5 000 000 <br /> I RETENTION $ <br /> BAM � MNGIIC0000076901 7/3112020 07/3112021 X = OTM <br /> ANY PROPRI�ETORIPARTNERID�C rwF—y] MIA E.L.EACH ACCIDENT i1 OOO OOO <br /> OOFFFFICERIME FJ2 D(CLI�ED? <br /> (YyysMss11,,dllery In WQ E.L.DISEASE-EA EMPLOYEE $1 000 000 <br /> IDESCttIPT10N'OPWOPERATIONS below E.L.DISEASE-POUCY LIMIT 0,000,000 <br /> A Equipment FI NGIICIM0000100 OW0212020 0610212021 511tem$2,500 Min deduc <br /> DESCRrTM OF OPERATIONS I LOCATIONS I VEI I WTICUM PUMD 11H. WW RwnMks 3eMAI/a,cry a atlaelMO I anaa apata Y eaq�dnd) <br /> "Workers Comp Information" <br /> P ecutive OfflcerslMembers Excluded: <br /> Ricky Kirk,Presided <br /> Jerry Wells,Vice President <br /> (See Attached Descriptions) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Colorado Division of THE EXPIRATION DATE THEREOF, NOTICE WSJ. BE DELNER:n IN <br /> Reclamation,Mining,and Safety ACCORDANCE WITH THE POLICY PROIVISRONS. <br /> Dept of <br /> 1313 Sherman St Room 215 Auniamm REPVJMWATK <br /> Denver,CO 80203 <br /> 0 I NO-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(201 GM3) 1 of 2 The ACORD name and logo are registered marks of ACORD <br /> 567447 AXSFB <br />