2022-06-01_GENERAL DOCUMENTS - C1983059

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A�---� ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 0 05/23/2022 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. PHONE NAME. �- Dallas TX Office (A/C No.Ext): (866) 283-7122 NC No.): (800) 363-0105 4) 5005 Lyndon B Johnson Freeway EMAIL p suite 1500 ADDRESS: _ Dallas TX 75244 USA INSURER(S)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 INSURER C: west Palm Beach FL 3 3 401-8101 USA INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570093186854 REVISION NUMBER: r- 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 INSD WVD POLICY NUMBER MM/DDIYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR General Liablity $1,000,000 SIR applies per policy terns & conditions PREMISES Ea occurrence MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER* GENERAL AGGREGATE $4,000,000 POLICY PE �X LOC PRODUCTS•COMP/OP AGG $2,000,000 CT OTHER o n A BAP 9265950-12 06/01/2022 06/01/2023 COMBINED SINGLE LIMIT n AUTOMOBILE LIABILITY E accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) 4) AUTOS ONLY AUTOS W x HIRED AUTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident 1D H 11 d B X UMBRELLA LIAB ECLAIIS-MADE R AUc926593712 06 O1 022 0 1 202 EACH OCCURRENCE $15,000,000 U Umbrella AGGREGATE $15,000,000 EXCESS LIAB DED I X RETENTION$10,000 WORKERS COMPENSATION AND PER STATUTE I 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 as,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT T-1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 'F+ RE: Elk and Sanborn Creed Mines, Permit# C-1981-022. Commercial General Liability Coverage includes the use of explosives. RECEIVED CERTIFICATE HOLDER CANCELLATION DESCRIBEDJ1 SHOULD ANY OF THE ABOVE UN 2022 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE g (�OF RE oC A POLICY PROVISIONS. Division Of Minerals & Geol O �" CLAMA HORIZED REPRESENTATIVE 1313 Sherman street iQANO S Room 215 `+�«i t � Denver CO 80203 USA Q 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD