2021-06-08_GENERAL DOCUMENTS - C1981022

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A�/?O----, ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) os/z7/zo21 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 21) certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT p Aon Risk Services Southwest, Inc. NAME. FAX �- PRO No.Ext): (866) 283-7122 A/C.No.; (800) 363-0105 (D Dallas Tx Office �'�C® v , G ADDRESS: _ 5005 Lyndon B 3ohnson Freeway suite 1500 v. Dallas Tx 75244 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins Co 16535 Oxbow Mining, LLC INSURER B: 1601 Forum Place '[IQN Suite 1400 IVISION OF REGIANI�► INSURER C: West Palm Beach FL 33401-8101 USA pMINING AND SAFETY INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570087451542 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 INSR LTR TYPE OF INSURANCE IVSD yWvp POLICY NUMBER MM/DD/YYY MM/DD/YYYY POLICY EF LIMITS X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADE F OCCUR SIR applies per policy terns & conditions _ $1,000,000 PREMISES Ea occurrence MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATEUn POLICY ❑JEPRO t CT ❑X LOC PRODUCTS-COMP/OPAGG $2,000,000 coo OTHER n A AUTOMOBILE LIABILITY BAP 9265950-11 06/01/2021 06/01/2022 CEOMBINED SINGLE LIMIT $1,000,000 ( accident) X ANYAUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) d AUTOS ONLY P AUTOS lC X HIREDAUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY Per accident w 1: d UMBRELLA LIAB OCCUR EACH OCCURRENCE U EEXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND PER STATUTE I OTTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER I—EXECUTIVE Y/N E L EACH ACCIDENT OFFICEWMEMBER EXCLUDED'+ ❑ N/A (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,maybe attached if more space is required) RE: Elk Creek Mine Permit #1981 - 022 a� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE - EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE - POLICY PROVISIONS. Division of Reclamation AUTHORIZED REPRESENTATIVE Mining and safety - 1313 Sherman Street Room 215 Denver CO 80203 USA 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD