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AGENCY CUSTOMER ID: 570000083411 <br /> LOC#: <br /> ADDITIONAL REMARKS SCHEDULE Page _ of _ <br /> AGENCY NAMEDINSURED <br /> Aon Risk services southwest, Inc. oxbow Energy Solutions LLc <br /> POLICY NUMBER <br /> see certificate Number: 570099642681 <br /> CARRIER 77CODE1 <br /> See certificate Number: 570099642681 EFFECTIVE DATE <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br /> Additional Description of Operations/Locations/Vehicles <br /> commercial General Liability covers use of explosives. <br /> Division of Minerals & Geology is named as an Additional insured excluding workers' compensation and <br /> Employers' Liability as required by written contract but limited to the operations of the Insured under said <br /> contract, and always subject to the policy terms, conditions and exclusions. <br /> ACORD 101(2008/01) ®2008 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />