2021-06-08_GENERAL DOCUMENTS - C1983059 (2)

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.�a�coo�rv® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/05/27/20212021 Y) 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 CONTACT NAME: Aon Risk Services Southwest, Inc. PHONE Dallas TX Office (A/C.No.Ext): (866) 283-7122 A/C.No.: (800) 363-0105 ) 5005 Lyndon B Johnson Freeway E-MAIL 32 Suite 1500 ADDRESS: _ Dallas Tx 75244 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins CO 16535 oxbow Mining, LLC INSURER B: American Guarantee & Liability Ins Co 26247 1601 Forum Place Suite 1400 INSURER C: West Palm Beach FL 33401-8101 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570087451543 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 AUDL SLUR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADE M OCCUR SIR applies per policy terns & conditions DAMAUE TO RENTED— $1,000,000 PREMISES Ea occurrence MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $4,000,000 POLICY ❑PRD LOC PRODUCTS-COMP/OPAGG $2,000,000 00 OTHER. o A AUTOMOBILE LIABILITY BAP 9265950-11 06/01/202106/01/2022 COMBINED SINGLE LIMIT $1,000,000 LO Ea accident) IXX ANYAUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) d AUTOS ONLY AUTOS HIREDAUTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident w .C. d B X UMBRELLALIAB X OCCUR AUC926593711 06/01/2021 0601 2022 EACH OCCURRENCE $15,000,000 U EXCESS LIAB CLAIMS-MADE AGGREGATE $15,000,000 DED I X IRETENTION 410,000 WORKERS COMPENSATION AND PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E L EACH ACCIDENT OFFICER/MEMBER EXCLUDED9 N/A (Mandatory in NH) E L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT 1 22 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) i■ RE: Permit number C - 1983-059 Terror Creek Loadout i• Division of Reclamation, Mining and safety is included as Additional Insured as required by written contract, but limited to the operations of the insured under said contract, per the applicable endorsement with respect to the General Liability, Automobile Liability, and umbrella Liability policies. 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, Mining AUTHORIZED REPRESENTATIVE and Safety X 1313 Sherman Street, Room 215 IQL 6�L_ e otl y�aJL 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