2022-06-01_GENERAL DOCUMENTS - C1983059

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DATE(MWDD/YYYY) A�RD CERTIFICATE OF LIABILITY INSURANCE I 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 LD certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT AOn Risk Services Southwest, Inc. NPHONE AME. FAX Dallas TX Office (A/C.No.Ext): (866) 283-7122 AC.No.: (800) 363-0105 ) 5005 Lyndon B Johnson Freeway EMAIL 0 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 INSURERC: West Palm Beach FL 3 3 401-8101 USA INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570093186883 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 Imp yyyp POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY GLO EACH OCCURRENCE $2,000,000 CLAIMS-MADE - OCCUR 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 0 00 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $4,000,00000 POLICY PRO ❑X LOC PRODUCTS-COMP/OP AGG $2,000,000 M 0 OTHER. o n A AUTOMOBILE LIABILITY BAP 9265950-12 06/01/2022 06/01/2023 COMBINED SINGLE LIMIT $1,000,000(Ea accident) N BODILY INJURY(Per person) 0 X ANYAUTO Z OWNED SCHEDULED BODILY INJURY(Per accident) d AUTOS ONLY AUTOS PROPERTY DAMAGE t9 X HIREDAUTOS NON-OWNED Per accident w_ ONLY AUTOS ONLY 1: d B X UMBRELLALIAB X OCCUR AUc926593712 06 O1 2022 06 O1 2023 EACH OCCURRENCE $15,000,000 U EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$10,000 WORKERS COMPENSATION AND PER STATUTE I OTH- EMPLOYERS'LIABILITY Y ER ANY PROPRIETOR/PARTNER/EXECUTIVE /N E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED9 ❑ N/A (Mandatory In NM E.L.DISEASE-EA EMPLOYEE If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Permit number c - 1983-059 Terror creek Loadout �iSN 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. RECTImn CERTIFICATE HOLDER CANCELLATION t i. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE r ^F RECLAR: �.�� POLICY PROVISIONS. Division Of Reclamation, Mining AND SAFE){ AUTHORIZED REPRESENTATIVE and Safety Denver Sherman Street, Room 215 qr X /Igoe d r�14. JL Denver c0 80203 USA c.Y,Ko�a .�6� 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD