2008-07-07_GENERAL DOCUMENTS - C1980003

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MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER NYC-001 141518-12 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Marsh USA, Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE 1166 Avenue of the Americas POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE New York, NY 10036 AFFORDED BY THE POLICIES DESCRIBED HEREIN. Attn: NEWYORK.CERTS@MARSH.COM/Fax: 212-948-0500 COMPANIES AFFORDING COVERAGE COMPANY 08046---08-09 A N/A INSURED COMPANY W. R. GRACE & CO. 0? B Hartford Fire Insurance Co u 7500 GRACE DRIVE L COLUMBIA MD 44 ??` COMPANY , 210 - 2i'f? ??' 1 C A OS K?G w ? 00 N/ DIV0 qr4 WIN, COMPANY D Hartford Insurance Company of l COVERAGES This certificate supersedes and replaces any previously issued certificate for thepolicy period noted below. 4 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMJDD/YY) DATE (MM/DD/YY) GEN ERAL LIABILITY SELF INSURED 06/30/08 - 06/30/09 GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ CLAIMS MADE lkl OCCUR PERSONAL & ADV INJURY $ 5,000,000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 5,000,000 X SELF-INSURED FIRE DAMAGE (Any one fire) $ 5,000,000 R. GRACE & CO MEDEXP(Any one person) $ EXCLUDED D AUT OMOBILE LIABILITY 10 CSE C47908 (AOS) 06/30/08 06/30/09 COMBINED SINGLE LIMIT $ 2,000,000 B X ANY AUTO 10 CSE C47908 (IN, OK) 06/30/08 06/30/09 ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ 1 -1 GA RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: E EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 10 WBR C47907 (WI) 06/30/08 06/30/09 WC STATU- OTH- X TORY LIMITS ER - CO,CT,FL,GA,IA,MO,NE,NV,NY,O, 06/30/08 06/30/09 EL EACH ACCIDENT Is 21000,000 D THE PROPRIETOR/ X INCL 10 WN C47906 (CO,CT) 06/30/08 06/30/09 EL DISEASE-POLICY LIMIT $ 21000,000 PARTNERS/EXECUTIVE OFFICERS ARE: OFFICERS EXCL KS,LA,MA,MD,ME,MI,NH,NJ,NM,O 6/30/08 06/30/09 EL DISEASE-EACH EMPLOYEE $ 2,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS The coverage and limits stated above apply to Permit #C80-003 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE HALL ENDEAVOR TO MAIL I DAYS WRITTEN NOTICE TO THE Colorado Division of Minerals and CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Geology Attn: Jim Stark LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE 1313 Sherman Street - Room 215 D CO 80203 ISSUER OF THIS CERTIFICATE. enver, AUTHORIZED REPRESENTATIVE of Marsh USA Inc. BY: David Kong MM1(3/02) VALID AS OF-06/27/08