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ACORD CERTIFICATE OF LIABILITY~iRtSURANCE OP ID Rw <br />SEMCO-1 DATE (MM/DD/YYYY) <br />06 30 06 <br />PRODUCER <br />FiIIB International Southwest <br />Blanchard Insurance Group <br />P .O. Box 60130 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Grand Junction CO 81506 <br />Phone:970-245-8011 Fax: 970-245-8016 <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURED \ <br />~ INSURER A: Em 10 era Mutual Casualt C <br />r <br />(-` <br />A~~~ INSURER B: <br />QO <br />L U <br />SEM Cona ruc tioa CO. ``KK__ I <br />~ INSURER C: <br />~ <br />627 24 1~2 Rd, IInit I \ <br />G <br />d <br />ti <br />~ URER D: <br />ran <br />Junc <br />on CO 81505 ~ <br />. <br />J PdG <br />INSURER E: <br />COVERAGES n*" <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO ~9.IYSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR ODTIER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUaIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DO V DATE MM/DD/Y1' LIMITS <br /> GENERAL LUBILITY EACH OCCURRENCE E 1 , OOO r OOO <br />A X COMMERCIAL GENERALLIABILITY 9X90868 05/10/06 05/10/07 PREMISES (Eaoccurence) E100r000 <br /> CLAIMS MADE X^ OCCUR ~~ ~ MED EXP (Any one person) E 5 r UDD <br /> PERSONALBADV INJURY E1r OOO, DDO <br /> GENERAL AGGREGATE $ZrOOO, DUD <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG EZrOOOrOOO <br /> POLICY PRO LOC <br />JECT <br /> AUT OMOBILE LIA8ILITV <br />COMRINEDSINGLELIMB <br />E 1 OOO OOO <br />A X ANV AUTO 9X90868 OS~1O~O6 OS~lO~O7 (Ea accitlenq r r <br /> ALL OWNED AUTOS <br />BODILY INJURY <br /> <br />SCHEDULED AUTOS <br /> <br />(Per person) $ <br /> X HIRED AUTOS BODILY INJURY <br /> X NON-0WNED AUTOS (Per acrjtlent) E <br /> PROPERTY DAMAGE <br /> <br />(Per accitleni) $ <br /> GA RAGE LIABILITY AUTO ONLY-EA ACCIDENT E <br /> ANV AUTO OTHER THAN EA ACC E <br /> AUTO ONLY: AGG E <br /> EXCESSNMBRELLA LIABILITY EACH OCCURRENCE E <br /> <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> E <br /> DEDUCTIBLE 8 <br /> RETENTION E S <br /> WORKERS COMPENSATION AND TORY LIMITS ER <br /> EMPLOYERS' LIABILITY <br /> <br />_ <br />ANV PROPRIETOR/PARTNER/EXECUTIVE ~ _ _ <br />- ~ _ <br />~ _ <br />-° - <br />E.LrEACH ACCIDENT <br />$ - _ - - <br /> OfFICERIMEMBEREXCLUDE09 E.L. DISEASE-EA EMPLOYEE E <br /> If Yes. tlestribe untler <br /> SPECIAL PROVISIONS beIOw E.L. DISEASE-POLICY LIMIT $ <br /> OTHER <br />DESC RIPTION OF OPERATIONS /LOCATIONS /VEHIC LES / EXCLUSIONS ADDED BV ENDORSE MENT /SPECIAL PRO VISIONS <br />RE: Blue Ribbon Mine-File No C-81-047. State Of Colorado, Division Of <br />Minerals & Geology is included as an Additional Insured.*10 Days Notice Due <br />to Non-Payment Of Premium.**Or incur substantive changes or failure to <br />renew. <br />CERTIFICATE HOLDER CANCELLATION <br />D D O D D D O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />State Of COlOradO GATE THEREOF, THE ISSUING INSURER WILL BFmEA916irRMAIL *3O DAYS WRITTEN <br />Division Of Minerals & GEIOSOgy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,bYF-FMLYR630AOFB61N6L <br />1313 Sherman Street Room 215 I <br />Denver CO 80203 , <br />~ ACORD 25 (2001106) <br />