2023-06-08_GENERAL DOCUMENTS - C1983059

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DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE I 06/31l2023 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 I21) certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: Aon Risk Services Southwest, Inc. PHONE <866) 283-7122 FAX (800) 363-0105 Dallas TX office (A/C.No.Ext): wC.No. 5005 Lyndon B Johnson Freeway E-MAIL p Suite 1500 ,,, ADDRESS: _ Dallas TX 75244 USA k.—w oalr INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: American Guarantee & Liability Ins Co 26247 Oxbow Mining, LLC INSURERS: 1601 Forum Place JuN 0 8 2023 Suite 1400 INSURERC: West Palm Beach FL 33401-8101 USA INSURER D: Colarad001\4Sion of Redeff, , INSURER E: ndfetil INSURER F: COVERAGES CERTIFICATE NUMBER:570099642717 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 IN SD WVD POLICY NUMBER MM DD/YYY M DD( YYY LIMITS X COMMERCIAL GENERAL LIABILITY GLOW15594913 EACH OCCURRENCE $2,000,000 CLAIMS-MADE M OCCUR SIR applies per policy terns & conditions UAMAUE IOHFN I ED $1,000,000 PREMISES Ea occurrence MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY ❑PRO ❑X LOC PRODUCTS-COMP/OP AGG $2,000,000 0 OTHER: a t` A AUTOMOBILE LIABILITY BAP 9265950 13 06/01/2023.06/01/2024 COMBINED SINGLE LIMIT $1,000,000 � Ea accident) BODILY INJURY{Per person) C JX ANYAUTO Z OWNED SCHEDULED BODILY INJURY(Per accident) )AUTOS ONLY AUTOSHIREDAUTOS NON-OWNED PROPERTY DAMAGE p ONLY AUTOS ONLY Per accident t: d A X UMBRELLALIAB X OCCUR AUC92659371 0 01 2023 06 Ol 2024 EACH OCCURRENCE $15,000,000 U EXCESSLIAB CLAIMS-MADE AGGREGATE $15,000,000 DED 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 EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT __7 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 - Division of Reclamation, Mining and safety is included as Additional insured as required by written contract but limited to A the operations of the insured under said contract, per the applicable endorsement with respect to the Generail Liability, Automobile Liability, and umbrella Liability policies. MW CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. E'd Division Of Reclamation, Mining AUTHORIZED REPRESENTATIVE and safety 1313 Sherman street, Room 215 Denver CO 80203 USA '�ey y� eJL rk Denv 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD