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<br /> ,.t�Ra CERTIFICATE OF LIABILITY INSURANCE 08/29/2025
<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.IfZS
<br /> .
<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). c
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<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Aon Risk Services Southwest, Inc. PHONE (866) 283-7122 — (800) 363-0105 r,O
<br /> Houston TX Office (A/C.No.Eat): (A/C.No.):
<br /> 1300 Post oak Blvd., Suite 1400 E-MAIL c
<br /> Houston TX 77056 USA ADDRESS: _
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED INSURER A: Imperium Insurance Company 35408
<br /> GCC Energy, LLC INSURER B: Great Midwest Ins CO 18694
<br /> 6473 County Road 120
<br /> Hesperus Co 81326 USA INSURER C: Rockwood Casualty Ins Co 35505
<br /> INSURER D:
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: 570115180447 REVISION NUMBER: Ell
<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 ADDL SUER POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DO/YYYY),..(MM/DO/YYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY MNGIICGL000038605 09/01/2025 09/01/2026 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000,000 v
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 W
<br /> X POLICY PRO- I ILOC PRODUCTS-COMP/OPAGG $2,000,000 ro-
<br /> JECT
<br /> OTHER: $10000 _ o
<br /> ti
<br /> A MNG-IIC-CA-0000251-05 09/01/2025 09/01/2026 COMBINED SINGLE LIMIT n
<br /> AUTOMOBILE LIABILITY $1,OOO,000
<br /> (Ea accident) ..
<br /> X ANY AUTO
<br /> BODILY INJURY(Per person) G
<br /> Z
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) rd1.
<br /> AUTOS ONLY AUTOS
<br /> HIRED AUTOS
<br /> NON-OWNED PROPERTY DAMAGE U
<br /> ONLY AUTOS ONLY (Per accident)
<br /> i
<br /> d
<br /> B UMBRELLA LIAB X OCCUR MNGGMCX00003S201 09/01/2025 09/01/2026 EACH OCCURRENCE $5,000,000 0
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION
<br /> C WORKERS COMPENSATION AND WC707801 09/01/2025 09/01/2026 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 EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<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 if more space is required) r
<br /> 14
<br /> RE: OSM Permit CO-0106, CDRMS Permit CO-1981-035. Colorado Division of Reclamation, Mining & Safety is included as Additional
<br /> Insured in accordance with the policy provisions of the General Liability policy.
<br /> 31
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<br /> CERTIFICATE HOLDER CANCELLATION 94 W
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<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE WI n
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THEvs
<br /> POLICY PROVISIONS. g
<br /> Colorado Division of Reclamation, AUTHORIZED REPRESENTATIVE O
<br /> < n Mining & Safety . o
<br /> 1313 Sherman Street, Room 215 Our
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<br /> Denver co 80203 USA i � SeLes __ �L g
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<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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