2024-06-11_GENERAL DOCUMENTS - C1981022

Home Browse Search

'--.40 ® DATE(MM/DD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 06/03,2024 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 ° ;,—..1 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c PRODUCER CONTACT N 11 NAME: Aon Risk Services Southwest, Inc. PHONE FAX Dallas TX Office (A/C.No.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105 d 5005 Lyndon B Johnson Freeway ECE-MAIL E-MAIL a Suite 1500 p C Y ADDRESS: _ Dallas TX 75244 USA R INSURER(S)AFFORDING COVERAGE NAIC# INSURED tAUN 112024 INSURER A: Zurich American Ins CO 16535 Oxbow Energy Solutions LLC ATiQNINSURERB: American Guarantee & Liability Ins Co 26247 1601 eF1400 Place �Iv'S'�N OF RECLAM v INSURER C: West Palm Beach FL 33401-8101 USA M�N�NG AND SAFI' INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570106025408 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 !NSW ADDL-SUBR POLICY EFF POLICY-EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY (MM/DD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY GL0926594914 06/Ol/2024 06/01/2025 EACH OCCURRENCE $2,000,000 CLAIMS-MADE I X OCCUR General Liablity DAMAGE10 REN rED $1,000,000 SIR applies per policy terns & conditions PREMISES(Ea occurrence) — MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 p GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $4,000,000 N POLICY I JEPCT X LOC PRODUCTS-COMP/OPAGG $2,000,000 0 OTHER o A AUTOMOBILE LIABILITY BAP 9265950 14 06/01/2024 06/01/2025 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) , X ANY AUTO BODILY INJURY(Per person) O Z OWNED —SCHEDULED BODILY INJURY(Per accident) r AUTOS ONLY AUTOS X HIRED AUTOS —NON-OWNED PROPERTY DAMAGE ONLY _AUTOS ONLY (Per accident) F to o- B X UMBRELLA LIAB X OCCUR AUC926593714 06/01/2024 06/01/2025 EACH OCCURRENCE $15,000,000 U — EXCESS LIAB CLAIMS-MADE Umbrella AGGREGATE $15,000,000 DED X RETENTION 310,000 WORKERS COMPENSATION AND PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT OFFICER/MEMBER EXCLUDED') N/A (Mandatory in NH) E L DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT MI n DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Elk and Sanborn Creed Mines, Permit# C-1981-022. Commercial General Liability Coverage includes the use of explosives. i N 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 5 POLICY PROVISIONS.ki" Division of Minerals & Geology AUTHORIZED REPRESENTATIVE 1313 Sherman Street V C le._., o Room 215SJ' ,��_,� Y�Yet Denver Co 80203 USA Sig J� a Wil 1 iiii ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD