2024-09-10_GENERAL DOCUMENTS - C1981035

Home Browse Search

ACO DAT 0(M 0/DDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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 iti SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this — certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c PRODUCER CONTACT -00 NAME: AOn Risk Services Southwest, Inc. PHONE FAX Houston TX Office (A/C.No.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105 a 1300 Post Oak Blvd., Suite 1400 E-MAIL 0 Houston TX 77056 USA ADDRESS: X INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Rockwood Casualty Ins Co 35505 GCC Energy, LLC INSURER B: Imperium Insurance Company 35408 6473 County Road 120 Hesperus CO 81326 USA INSURER C: Great Midwest Ins Co 18694 INSURER D: INSURER E: INSURER F: ; COVERAGES CERTIFICATE NUMBER:570107959317 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 ADM SUBR POLICY hl-F POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) fI MM/DD/YYY1) LIMITS B X COMMERCIAL GENERAL LIABILITY MNGIICGL000038604 09/01/2024 09/01/2025 EACH OCCURRENCE $1,000,000 n DAMAGE TO RENTED CLAIMS-MADE I I OCCUR PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADVINJURY $1,000,000 r GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 0 POLICY JECT RO- n LOC PRODUCTS-COMPlOPAGG $2,000,000 0 OTHER: $10000 O B AUTOMOBILE LIABILITY MNG-IIC-CA-0000251-04 09/01/2024 09/01/2025 COMBINED SINGLE LIMIT $1,000,000 N (Ea accident) .. BODILY INJURY(Per person) 0 X ANY AUTO Z OWNED SCHEDULED BODILY INJURY(Per accident) w AUTOS ONLY AUTOS 0 HIRED AUTOS NON-OWNED PROPERTY DAMAGE 0 ONLY _AUTOS ONLY (Per accident) r 4) C UMBRELLA LIAB X OCCUR MNGGMCX000035200 09/01/2024 09/01/2025 EACH OCCURRENCE $5,000,000 0 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION A WORKERS COMPENSATION AND WC705346 09/01/2024 09/01/2025 x PER STATUTE OTTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ' N I N/A (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— n DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) RE: OSM Permit CO-0106, CDRMS Permit CO-1981-035. Colorado Division of Reclamation, Mining & Safety is included as Additional Siell Insured in accordance with the policy provisions of the General Liability policy. S m+.. -0 D I CERTIFICATE HOLDER CANCELLATION ° § SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE g EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. g Colorado Division of Reclamation, AUTHORIZED REPRESENTATIVE a`. Mining & Safety o 1313 Sherman Street, Room 215 ` �� rr^ Denver CO 80203 USA Ell 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD