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AR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<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 ::
<br /> SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this .42,.
<br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .c
<br /> PRODUCER CONTACT CD
<br /> 'CO
<br /> NAME:
<br /> Aon Risk Services Southwest, Inc. PHONE FAX b-
<br /> Dallas TX Office (A/C.No.Eat): (866) 283-7122 (A/C.No.): (800) 363-0105
<br /> 5005 Lyndon B Johnson Freeway �p `. E-MAIL p
<br /> Suite 1500 ,yECEIV ED
<br /> ADDRESS: _
<br /> Dallas Tx 75244 USA {'j`
<br /> INSURER(S)AFFORDING COVERAGE NAIL#
<br /> INSURED INSURER A: American Guarantee & Liability Ins Co 26247
<br /> Oxbow Energy solutions LLC JUN 0 320Z5 INSURER B: Zurich American Ins Co 16535
<br /> 1601 Forum Place
<br /> Suite 1400 INSURER C:
<br /> West Palm Beach FL 3 3 401-8101 USA pIVISIOn Of Reclamation,
<br /> INSURER D:
<br /> Coloradoand Safety
<br /> Mlning INSURER E:
<br /> INSURER F: •
<br /> COVERAGES CERTIFICATE NUMBER:570112757745 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> * *
<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 /> INSR ADDLLSUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY M/DD/YYYY) LIMITS
<br /> B X COMMERCIAL GENERAL LIABILITYGL0926594915 06/01/2025 f(M 06/01/2026 EACH OCCURRENCE $2,000,000
<br /> CLAIMS-MADE I X 'OCCUR SIR applies per policy terms & conditions DAMAGE TO RENTED $1,000,000
<br /> PREMISES(Ea occurrence)
<br /> MED EXP(Any one person) $10,000
<br /> PERSONAL&ADV INJURY $1,000,000 v
<br /> GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 E-
<br /> PRO-
<br /> 1 POLICY I IJ CT n LOC PRODUCTS-COMP/OPAGG $2,000,000 N
<br /> OTHER. o
<br /> B AUTOMOBILE LIABILITY BAP 9265950 15 06/01/2025 06/01/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> (Ea accident) - ..
<br /> 0
<br /> BODILY INJURY(Per person)
<br /> X ANY AUTO Z
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) w
<br /> AUTOS ONLY AUTOS
<br /> X HIRED AUTOS NON-OWNED PROPERTY DAMAGE U
<br /> ONLY AUTOS ONLY (Per accident) jr
<br /> t
<br /> lV
<br /> A X UMBRELLA LIAB X OCCUR AUC926593715 06/01/2025 06/01/2026 EACH OCCURRENCE $15,000,000 0
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $15,000,000
<br /> DED X RETENTION$10,000
<br /> B WORKERS COMPENSATION AND WC937757222 06/01/2025 06/01/2026 x PER STATUTE OTH-
<br /> EMPLOYERS'LIABILITY Y/N ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED1 N N/A
<br /> (Mandatory in NH) E L DISEASE-EA EMPLOYEE $1,000,000
<br /> II yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $1,000,000—
<br /> g
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached tf more space is required)
<br /> RE: Terror Creek LLC C-1983-059
<br /> Division of Minerals & Geology is included as an Additional Insured as required by written contract but limited to the
<br /> operations of the Insured under said contract, and always subject to the policy terms, conditions and exclusions. The General ;Ce�
<br /> policy evidenced herein covers use of explosives.
<br /> o.
<br /> CERTIFICATE HOLDER CANCELLATION cj
<br /> 0
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> g N
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE m
<br /> POLICY PROVISIONS. g
<br /> ,•' Di Vi si on of minerals & Geology AUTHORIZED REPRESENTATIVE r- o
<br /> 1313 Sherman Street �y��1 ' Q yr� 82
<br /> Room 215 ,J. io�oi is%-x _ .0,e,a d Y lS,1L e./ et ram}^
<br /> Denver CO 80203 uSA �
<br /> 1111
<br /> ©1988-2015 ACORD CORPORATION.All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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