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AGENCY CUSTOMER ID: 570000083411 <br /> ® LOC#: <br /> "A ' ADDITIONAL REMARKS SCHEDULE Page _ of _ <br /> AGENCY NAMED INSURED <br /> Aon Risk Services southwest, Inc. Oxbow Energy Solutions LLC <br /> POLICY NUMBER <br /> See Certificate Number: 570113075558 <br /> CARRIER NAIC CODE <br /> See Certificate Number: 570113075558 EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability insurance <br /> Additional Description of Operations/Locations/Vehicles: <br /> Commercial General Liability covers use of explosives. <br /> Division of Minerals & Geology is named as an Additional Insured excluding Workers' Compensation and <br /> Employers' Liability as required by written contract but limited to the operations of the Insured under said <br /> contract, and always subject to the policy terms, conditions and exclusions. <br /> ACORD 101(2008/01) ®2008 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />