2025-06-03_GENERAL DOCUMENTS - C1981022

• Permit No: C1981022
• IBM Index Class Name: General Documents
• Doc Date: 6/3/2025
• Doc Name: Certificate of Insurance
• From: AON Risk Services
• To: DRMS
• Email Name: LDS
• Email Name: AME
• Media Type: D
• Archive: No

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CERTIFICATE OF LIABILITY INSURANCE 05/27/2025
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
41
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
Dallas TX Office (NC.No.Ext): [phone] (A/C.No.): [phone]
5005 Lyndon B Johnson Freeway E-MAIL p
Suite 1500 ADDRESS: I
Dallas TX 75244 USA
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: Zurich American Ins Co 16535
Oxbow Mining, LLC INSURER B:
1601 Forum Place
Suite 1400 INSURER C:
West Palm Beach FL 33401-8101 USA INSURER D:
INSURER E:
INSURER F: ,
COVERAGES CERTIFICATE NUMBER:570112757747 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 ADDL SUBR POLICY EFF POLICY-EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY [MM/DD/YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY GL0926594915 06/01/2025 06/O1/2026 EACH OCCURRENCE $2,000,000
CLAIMS-MADE X OCCUR SIR applies per policy terns & conditions DAMAGE TORENMED $1,000,000
PREMISES(Ea occurrence)
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000 v
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 N
POLICY JECTR X LOC PRODUCTS-COMP/OPAGG $2,000,000 N
OTHER. 0
t`
A BAP 9265950 15 06/01/2025 06/01/2026 COMBINED SINGLE LIMIT `'
AUTOMOBILE LIABILITY $1
(Ea accident) ,000,000
BODILY INJURY(Per person) 0
X ANY AUTO Z
OWNED —SCHEDULED BODILY INJURY(Per accident) N
AUTOS ONLY AUTOS W
X HIRED AUTOS NON-OWNED PROPERTY DAMAGE V
ONLY _AUTOS ONLY (Per accident) w
t:
N
UMBRELLA LIAB OCCUR EACH OCCURRENCE C.)
EXCESS LIAB CLAIMS-MADE
AGGREGATE
DED RETENTION
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 —
r —
I
2
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) =
RE: Elk Creek Mine Permit #1981 - 022 Z'
Pi
on
eL
CERTIFICATE HOLDER CANCELLATION ,i
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE R
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE f_ m
POLICY PROVISIONS. eg
r; Division of Reclamation AUTHORIZEDREPRESENTATIVE
o
Mining and Safety o
1313 Sherman street ��p 6Zile
Room 215 � � � o J�eJsa
Denver Co 80203 USA
11111
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