2024-06-11_GENERAL DOCUMENTS - C1983059 (3)

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,._...., ® ARa DATE(MM/DD/YYYY)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 w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). m PRODUCER CONTACT .a NAME: Aon Risk Services Southwest, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 d Dallas TX Office (A/C.No.Ext): (A/C.No.): 5005 Lyndon B Johnson Freeway E-MAIL c Suite 1500ADDRESS: _ Dallas TX 75244 USA RECEIVED INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Zurich American Ins Co 16535 Oxbow Mining, LLC jjN 112024 INSURER B: American Guarantee & Liability Ins Co 26247 1601 Forum Place ��N Suite 1400 OF I�ECLAMATIO 1�1 SURER C: West Palm Beach FL 33401-8101 USA INSURER D: DNISItN SAFTEY INSURER E: GAINING AND INSURER F: COVERAGES CERTIFICATE NUMBER:570106025447 REVISION NUMBER: Eilo:3'i 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 ADDL SUER POLICY EI-F POLICY EXP LTR TYPE OF INSURANCE INSD yWVD POLICY NUMBER (MM/DD/YYY (MM/DD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY GLo926594914 06/01/1024 06/01/2023' EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR SIR applies per policy terns & conditions DAMAGE TO RENTED $1,000,000 PREMISES(Ea occurrence) — MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 r GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,006 N POLICY I JERT X LOC PRODUCTS-COMP/OPAGG $2,000,000 0 OTHER o r` A BAP 9265950 14 06/01/202406/01/2025 COMBINED SINGLE LIMITLo AUTOMOBILE LIABILITY $1,000,000 (Ea accident) ,, X ANY AUTO BODILY INJURY(Per person) o Z OWNED —SCHEDULED BODILY INJURY(Per accident) d AUTOS ONLY AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE CO ONLY _AUTOS ONLY (Per accident) t d B X UMBRELLALIAB X OCCUR AUC926593714 06/01/2024 06/01/2025 EACH OCCURRENCE $15,000,000 V EXCESSLIAB CLAIMS-MADE AGGREGATE $15,000,000 DED X RETENTION$10,000 WORKERS COMPENSATION AND PER STATUTE OTH- EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR I 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 ffeti gEil 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 the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability, Automobile Liability, and Umbrella Liability policies. IA a CERTIFICATE HOLDER CANCELLATION Co - 8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE -• 8 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE _.,-J POLICY PROVISIONS. g Division of Reclamation, Mining AUTHORIZED REPRESENTATIVE Coo and Safety o 1313 sherman Street, Room 215 a ` �� rls- Denver CO80203 u5Ag4.40210/ o0 1111 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD