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2022-06-01_GENERAL DOCUMENTS - C1981022
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2022-06-01_GENERAL DOCUMENTS - C1981022
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Last modified
12/28/2024 7:06:03 PM
Creation date
6/2/2022 10:32:29 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981022
IBM Index Class Name
General Documents
Doc Date
6/1/2022
Doc Name
Certificate of Insurance
From
Aon Risk Services SW
To
DRMS
Email Name
LDS
JDM
Media Type
D
Archive
No
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DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE I <br /> 05/23/2022 <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(les)must have ADDITIONAL INSURED provisions or be endorsed.If <br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT p <br /> Aon Risk Services Southwest, Inc. NPNE AME. FAX <br /> Dallas TX Office (A/C.No.Ext): 366) 283-7122 A/C.No.): l 600) 363-0105 <br /> 5005 Lyndon B Johnson Freeway E-MAIL -6 <br /> suite 1500 ADDRESS: <br /> Dallas TX 75244 USA <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Zurich American Ins CO 16535 <br /> Oxbow Energy Solutions LLC INSURER B: American Guarantee & Liability Ins Co 26247 <br /> 1601 Forum Place <br /> Suite 1400 INSURERC: <br /> west Palm Beach FL 3 3 401-8101 USA INSURERD: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 570093186854 REVISION NUMBER: r- <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. Limits shown are as requested <br /> WISH LTR TYPE OF INSURANCE INSD WADDL VD POLICY NUMBER MM/DD/YYY MM/DD/YYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 <br /> CLAIMS-MADE E OCCUR General Liablity $1,000,000 <br /> SIR applies per policy terns & conditions PREMISES Ea occurrence <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,00000 <br /> POLICY PRO- ❑X LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> 0 <br /> CT <br /> OTHER <br /> n <br /> A AUTOMOBILE LIABILITY BAP 9265950-12 06/01/2022 06/01/2023 COMaBINEDSINGLELIMIT $1,000,000 rn <br /> (EaAINYAUTO BODILY INJURY(Per person) Z <br /> OWNED SCHEDULED BODILY INJURY(Per accident) QI <br /> AUTOS ONLY AUTOS !0 <br /> X HIREDAUTOS NON-OWNED PROPERTY DAMAGE V <br /> ONLY AUTOS ONLY Per accident <br /> X <br /> 1: <br /> N <br /> B X UMBRELLALIAB X OCCUR AUc926593712 06 01 2022 0 1 202 EACH OCCURRENCE $15,000,000 U <br /> CLAIMS-MADE umbrella AGGREGATE $15,000,000 <br /> EXCESS LIAR <br /> DED X RETENTION S10,000 <br /> WORKERS COMPENSATION AND PER STATUTE I OTH- <br /> EMPLOYERS'LIABILITY y/N ER - <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E L EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) EL DISEASE-EA EMPLOYEE <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 'F+ <br /> RE: Elk and Sanborn Creed Mines, Permit# C-1981-022. Commercial General Liability coverage includes the use of explosives. <br /> RECEIVED <br /> CERTIFICATE HOLDER A CANCELLATION <br /> 2022 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE g <br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br /> (/��� �C POLICY PROVISIONS. <br /> Division of Minerals & Geol OwV OF RECCAMA HORIZED REPRESENTATIVE g <br /> 1313 Sherman Street WOOANO «i <br /> B <br /> Room 215 AYs,4 ym¢�JL <br /> Denver CO 80203 USA <br /> 01988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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