|
l , vvVLVrUC-UI JKtllvalVIU
<br />CERTIFICATE OF LIABILITY INSURANCE DATE A0219O'91
<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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />NAME:
<br />Central Insurance Services PHONE FAX
<br />4630 Taylorsville Road (Arc, No, Ext): (502) 493-2370 ;ArC, No):(502) 493-2320
<br />Louisville, KY40220 E-MAIL ADDRESS: insurance@centralbank.com
<br />INSURED
<br />Wolverine Fuels, LLC
<br />Attn: Marc Maglione, Chief Financial Officer
<br />9815 South Monroe Street, Suite 203
<br />Sandy, UT 84070
<br />INSURERfS) AFFORDING COVERAGE NAIC #
<br />wsURERA:lmperium Insurance Company ,35408
<br />INSURER B : Houston Specialty Insurance
<br />kINSURER C:Argonaut Midwest Insurance Company +19828
<br />INSURERD:Admiral Insurance Company
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: RFVISIQN HUMRFR-
<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
<br />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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,_
<br />_POLICIES.
<br />INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY Err POLICY EXP
<br />LTR NSD SNVD M OR MM DD
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />g 1,000,000
<br />CLAIMS -MADE X OCCUR MNG-IIC-GL-0000157-00 5/112021 5/1/2022
<br />_
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />100,000
<br />F S
<br />MEDEXP(Anyone personl
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'LAGGREGATELIMITAPPLIEI PER:
<br />GENERAL AGGREGATE
<br />2,000,000
<br />POLICY JEO LOC
<br />PRODUCTS-COMP/OPAGG
<br />;$
<br />$ 2,000,000
<br />OTHER:
<br />g
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1,000,000
<br />F �acciden..S)
<br />�$
<br />X _ ANY AUTO
<br />f
<br />MNG-IIC-CA-0000107-00 5/1/2021 5/1/2022
<br />F BODILY INJURY (Per person]
<br />+_$
<br />OWNED SCHEDULED
<br />AUTO$ ONLY AUTOS
<br />BODILY INJURY Jeer accident?
<br />$
<br />HIRED NON -OWNED
<br />PROPERTYDAMAGE
<br />_ AUTOS ONLY AUTOS ONLY
<br />_ (Per accident]
<br />$
<br />13 X UMBRELLA LIAB X OCCUR
<br />{
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />EXCESS LIAB CLAMS -MADE
<br />'MNG-HS-CX-0000003-00 5I1I2021 5/112022
<br />10,000,000
<br />1 _
<br />AGGREGATE
<br />$_
<br />DED RETENTJON$
<br />C WORKERS
<br />EFLERN COMPENSATION
<br />OTTH-
<br />X. STATUTE
<br />ANMOYS LIABILITY YIN
<br />WC696035 2/1/2021 21112022
<br />F _ L
<br />r 1,000,000
<br />ANYPROPRIETORlPARTNERIEXECUTIVE
<br />OFFICERlMEMBEREXCLUDED?
<br />NIA
<br />E.L.ELACH ACCIDENT
<br />i
<br />$
<br />(Mandatory in NH)
<br />E,L DISEASE - EA EMPLOYEE,
<br />S 1,000,000
<br />If yez,
<br />1,000,000
<br />ESCRIPTIOeunder
<br />DESCRIPTION OF OPERATIONS below
<br />E,L,DISEASE-POLICY LIMIT
<br />i $
<br />D Pollution Liability FElEIL2095301 1 2/1/2021 5/112024
<br />!Aggregate/Occurrence
<br />10,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Evidence of Insurance as respects to Bowie #2 Mine Permit #C1996083 and Bowie #1 Mine Permit #C1981038. General Liability policy provides protection for
<br />use of explosives. The General Liability and Umbrella policies include an endorsement providing that 30 day notice
<br />of cancellation (or coverage change) will
<br />be furnished to the certificate holder by the carrier.
<br />State of Colorado Department of Natural Resource
<br />Div of Minerals & Geology
<br />1313 Sherman St, Room 215
<br />Denver, CO 8023D
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />TJAj/T�IVE
<br />rW"^�Y P • W- 1.1i I-r
<br />ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|