2023-06-06_GENERAL DOCUMENTS - C1983059

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DATE(MM/DD/YYYY) A�co,RO CERTIFICATE OF LIABILITY INSURANCE 05/31/2023 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 p Aon Risk Services southwest, Inc. NPHONE AME: Dallas TX Office \� D (A/C.No.Ezt): (866) 283-7122 (aC.No.): (B00) 363-0105 5005 Lyndon B Johnson Freeway A C�E E-MAIL = Suite 1500 KG ADDRESS: Dallas Tx 75244 USA 023 INSURER(S)AFFORDING COVERAGE NAIC# INSURED nQn� INSURER A: American Guarantee & Liability Ins Co 26247 oxbow Energy Solutions LLC Reclama INSURER B: 1601 Forum Place01 Suite 1400 D��$10n d gaficey INSURER C: ado west Palm Beach FL 33401-810130W Mtotngan INSURERD: INSURER E: INSURER F: , COVERAGES CERTIFICATE NUMBER: 570099642714 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 LTR TYPE OF INSURANCE IN o WVD POLICY NUMBER MM/DD/YYY MM/DD/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 APPLIESPER GENERAL AGGREGATE $4,000,000 POLICY ❑ ID JJE LOC PRODUCTS-COMP/OPAGG $2,000,000 0 CD OTHER r, A AUTOMOBILE LIABILITY BAP 9265950 13 06/01/2023 06/01/2024 COMBINED SINGLE LIMIT $1,000,000 Ea accident) .- X ANYAUTO BODILY INJURY(Per person) _ 0 OWNED SCHEDULED BODILY INJURY(Per accident) .4) AUTOS ONLY AUTOS PROPERTY DAMAGE ccX HIRED AUTOS NON-OWNED Paracadent +. ONLY AUTOS ONLY r d A X UMBRELLALIAB H OCCUR AUC926593713 06 01 2023 06 01 2024 EACH OCCURRENCE $15,000,000 U EXCESS LIAB CLAIMS-MADE AGGREGATE $15,000,000 DED I X RETENTION S10,000 WORKERS COMPENSATION AND PER STATUTE ORTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA A E L.EACH ACCIDENT OFFICER/MEMBER EXCLUDEDI (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If as,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) RE: Terror creek LLC c-1983-059 Division of Minerals & Geology is included as an Additional insured as required by written contract but limited to the operations of the insured under said contract, and always subject to the policy terms, conditions and exclusions. The General policy evidenced herein covers use of explosives. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE m EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Division of Minerals & Geology AUTHORIZED REPRESENTATIVE 1313 Sherman Street Room 215 � 17 y�✓tea g Denver co 80203 USA JQL g$ 9 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD