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2023-05-09_GENERAL DOCUMENTS - C1981038
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2023-05-09_GENERAL DOCUMENTS - C1981038
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Last modified
5/9/2023 2:52:31 PM
Creation date
5/9/2023 10:42:54 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981038
IBM Index Class Name
General Documents
Doc Date
5/9/2023
Doc Name
Certificate of Insurance
From
Marsh
To
DRMS
Email Name
RDZ
MAC
Media Type
D
Archive
No
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ACCMDO® DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 05/0412023 <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 /> MARSH USA LLC NAME: <br /> 525 Vine Street,Suite 900 PHONE AIC No: <br /> Cincinnati,OH 45202 E-MAIL <br /> ADDRESS: <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> CN1 15425941--GAX-22-23 INSURER A:Houston Specialty Insurance Company 12936 <br /> INSURED Wolverine Fuels,LLC INSURER B:Im enum Insurance Company 35408 <br /> Attn.Marc Maglione,Chief Financial Officer INSURER c:James River Insurance Company 12203 <br /> 9815 South Monroe Street,Suite 203 INSURER D:NIA N/A <br /> Sandy,UT 84070 <br /> INSURER E:NIA IN <br /> INSURER F <br /> Ej <br /> COVERAGES CERTIFICATE NUMBER: CLE-006879673-03 REVISION NUMBER: 3 <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 <br /> LICY EXP <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DD/YYYY POLICY EFF M/DD/YYYY LIMITS <br /> LTR <br /> A X COMMERCIAL GENERAL LIABILITY MNG-HS-GL-0000018-00 05/01/2023 05/01/2024 EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE a OCCUR PREMISES Eat oa ccurrence $ 100,000 <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PRO JECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER $ <br /> B AUTOMOBILE LIABILITY MNG-IIC-CA-0000107-02 05/01/2023 05101/2024 COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAB X OCCUR MNG-HS-CX-0000003-02 05/01/2023 05101/2024 EACH OCCURRENCE $ 5,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> CI I DEC) I I RETENTION$ 00130439-0 05/01/2023 05101/2024 Ea Occ/Agg,xs$5M $ 5,000,000 <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE I ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑N 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 I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Re Bowe#2 Mine Permit#C1996083 and Bowie#1 Mine Permit#C1981038 General Liability policy provides protection for <br /> use of explosives <br /> CERTIFICATE HOLDER CANCELLATION <br /> State of Colorado Department of SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Natural Resource THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Div of Minerals&Geology ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1313 Sherman St,Room 215 <br /> Denver,CO 80230 <br /> AUTHORIZED REPRESENTATIVE <br /> �aedl(c PL�'1ff..G.L:�i <br /> ©1988-2016 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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