2022-06-01_GENERAL DOCUMENTS - C1983059

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AC�® DATE05 3/DOD 2YYY) CERTIFICATE OF LIABILITY INSURANCE 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 Aon Risk Services Southwest, Inc. NAME. FAX ` Dallas TX Office (A/C.No.Ext): <866) 253-7122 A C.No.: (1300) 363-0105 5005 Lyndon B Johnson Freeway E-MAIL Suite 1500 ADDRESS: Dallas TX 75244 USA INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins CO 16535 oxbow Energy Solutions LLC INSURER B: American Guarantee & Liability Ins CO 26247 1601 Forum Place Suite 1400 INSURERC: west Palm Beach FL 33401-8101 USA INSURER D: INSURER E: INSURER F: , COVERAGES CERTIFICATE NUMBER: 570093186881 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 DULNSD Ut3 POLICY NUMBER FOLIC FFr1 MMlDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADE x❑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 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,00000 POLICY ❑PRO LOC rn 0 OTHER 0 n A AUTOMOBILE LIABILITY BAP 9265950-12 06/01/2022 06/01/2023 COMBINED SINGLE LIMIT $1,000,000 Eaaccident) „ X ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) w AUTOS ONLY AUTOS el X HIREDAUTOS NON-OWNED PROPERTYDAMAGE V ONLY AUTOS ONLY Per accident ;.- t: N B X UMBRELLA LIAB H OCCUR AUC926593712 06 O1 2022 06/01 2023 EACH OCCURRENCE $15,000,000 U LlEXCESS LIAB CLAIMS-MADE AGGREGATE $15,000,000 DED I X RETENTION$10,000 WORKERS COMPENSATION AND PER STATUTE I ORTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 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 E L DISEASE-POLICY LIMIT l� DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Terror Creek LLC C-1983-059 Division of Minerals & Geolo y isMs an Additional Insured as re uired by written contract but limited to the operations of the Insured under sr y ys subject to the policy terms, conditions and exclusions. The General policy evidenced herein covers us1' �CC u CERTIFICATE HOLDER It,A CANCELLATION W a�Rt�iq 'rw RE THE EXPIRATION DATE THER OFLA7MN SHOULD ANY OF THE ABF,, NOTIICECWILLL BE DELIVERED IN ACCORDANCE POLICIES BE CANCELLEDRIBED FWT H THE g - G ND WM POLICY PROVISIONS. Division of Minerals & Geology AUTHORIZED REPRESENTATIVE o ' 1313 Sherman street Room 215 Denver CO 80203 USA 0 0 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD