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2025-06-17_GENERAL DOCUMENTS - C1981022
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2025-06-17_GENERAL DOCUMENTS - C1981022
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Last modified
6/18/2025 8:04:44 AM
Creation date
6/17/2025 9:36:58 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981022
IBM Index Class Name
General Documents
Doc Date
6/17/2025
Doc Name
Certificate of Insurance
From
AON Risk Services
To
DRMS
Email Name
LDS
AME
Media Type
D
Archive
No
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____--..N ® DATE(MM/DD/YYYY) <br /> AID o CERTIFICATE OF LIABILITY INSURANCE <br /> 06/05/2025 <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 ;� <br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s). E <br /> CONTACT 0/ <br /> PRODUCER 'C <br /> NAME: <br /> Aon Risk Services Southwest, Inc. PHONE FAX al <br /> TX office (NC.No.Ext): (866) 283-7122 (NC.No.): (800) 363-0105 <br /> 5005 Lyndon B Johnson Freeway E-MAIL 0 <br /> Suite 1500 ADDRESS: _ <br /> Dallas TX 75244 USA <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: American Guarantee & Liability Ins Co 26247 <br /> oxbow Energy Solutions LLC INSURER8: Zurich American Ins Co 16535 <br /> 1601 Forum Place ' <br /> Suite 1400 INSURER C: <br /> West Palm Beach FL 3 3 401-8101 USA INSURER D: <br /> INSURER E: <br /> INSURER F: Y; <br /> COVERAGES CERTIFICATE NUMBER: 570113075563 REVISION NUMBER: <br /> .- <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 /> 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 AUDL-SUISR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYY MM(DD/YYYY) LIMITS <br /> B X COMMERCIAL GENERAL LIABILITY GL0926594915 —06/U1/202 S 06/01/2026 EACH OCCURRENCE $2,000,000 <br /> CLAIMS-MADE X OCCUR General Li abl i ty DAMAGE I O RENTED $1,000,000 <br /> SIR applies per policy terns & conditions PREMISES(Ea occurrence) <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 2 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 r <br /> PRO- <br /> POLICY JECT I "- 1LOC PRODUCTS-COMP/OPAGG $2,000,000 °i <br /> OTHER: C <br /> N. <br /> B BAP 9265950 15 `06/01/2025 06/01/2026 COMBINED SINGLE LIMIT to <br /> AUTOMOBILE LIABILITY (Ea accident) S1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) 0 <br /> Z <br /> OWNED SCHEDULED BODILY INJURY(Per accident) di <br /> — AUTOS ONLY _. AUTOS TO <br /> X HIRED AUTOS NON-OWNED PROPERTY DAMAGE V <br /> ONLY AUTOS ONLY (Per accident) ;r <br /> t <br /> AX UMBRELLA LIAB X OCCUR AUC926593715 06/01/2025 06/01/2026 EACH OCCURRENCE $15,000,000 <br /> U <br /> umbrella AGGREGATE $15,000,000 <br /> EXCESS LIAR CLAIMS-MADE <br /> DED X RETENTION S10,000 <br /> 8 WORKERS COMPENSATION AND wC937757222 06/01/2025'06/01/2026 x PER STATUTE 0TTH- <br /> EMPLOYERS'LIABILITY <br /> ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBER EXCLUDED? I N I N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— <br /> , n <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more apace is required) <br /> RE: Elk and Sanborn Creed Mines, Permit# C-1981-022. Commercial General Liability Coverage includes the use of explosives. .okk <br /> Ri <br /> CERTIFICATE HOLDER CANCELLATION iN <br /> ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE O <br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br /> POLICY PROVISIONS. <br /> r Division Sl On of Minerals & Geology AUTHORIZED REPRESENTATIVE � <br /> 1313 Sherman Street tr_.,i R <br /> Room 215 ��-f'/'� o ri <br /> Denver CO 80203 USA c a��� �4Amld V 4:9464 1-eid �ot7Q <br /> IIII <br /> 01988-2015 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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