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~-1r DATE(MM/DD/YYYY) <br /> coRcs CERTIFICATE OF LIABILITY INSURANCE 1 05/31/2023 <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.If L <br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT 00 <br /> NAME: <br /> Aon Risk Services Southwest, Inc. <br /> Dallas Tx Office (A/C.No.Ext): (666) 2f33-7122 Aac.No.; (800) 363-0105 <br /> 5005 Lyndon B Johnson Freeway E-MAIL 0 <br /> Suite 1500 ADDRESS: _ <br /> Dallas Tx 75244 USA <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: American Guarantee & Liability Ins CO 26247 <br /> oxbow Mining, LLC INSURER B: <br /> 1601 Forum Place <br /> Suite 1400 INSURER C: <br /> west Palm Beach FL 3 3 401-8101 USA INSURER D: <br /> INSURER E: <br /> INSURER'F: <br /> COVERAGES CERTIFICATE NUMBER:570099642715 REVISION NUMBER: <br /> THIS 1S 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. Limits shown are as requested <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITS <br /> X COMMERCIAL GENERAL LIABILITY GLO MM/DD/YYY MM/DD/YYY EACH OCCURRENCE $2,000,000 <br /> CLAIMS-MADE -OCCUR SIR applies per policy terns & conditions $1,000,000 <br /> PREMISES Ea occurrence <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 v <br /> POLICY ❑PRO- F LOC PRODUCTS-COMP/OP AGG $2,000,000 rn <br /> JECT 0 <br /> OTHER: o <br /> A AUTOMOBILE LIABILITY BAP 9265950 13 06/01/2023 06/01/2024 COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> BODILY INJURY(Per person) 0 <br /> JX ANYAUTO Z <br /> OWNED SCHEDULED BODILY INJURY(Per accident) GIAUTOS ONLYAUTOSHIREDAUTOS NON-OWNED PROPERTY DAMAGE V <br /> ONLY AUTOS ONLY Per accident t,.. <br /> t <br /> d <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE U <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DED RETENTION <br /> WORKERS COMPENSATION AND PER STATUTE I OTH- <br /> EMPLOYERS'LIABILITY Y/N ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE <br /> f Yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) sft <br /> RE: Elk Creek Mine Permit #1981 - 022 _r_ <br /> y_ <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> • <br /> EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE -- <br /> POLICY PROVISIONS. <br /> HIMDivision Of Reclamation AUTHORIZED REPRESENTATIVE <br /> Mining and Safety <br /> 1313 Sherman Street Room <br /> Room 215 / <br /> Denver CO 80203 USA <br /> 01988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />