2008-09-04_GENERAL DOCUMENTS - C1981035

• Permit No: C1981035
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 9/4/2008
• Doc Name: Certificate of Liability Insurance
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: TAK
• Media Type: D
• Archive: No

<.._.,._ - DATE(MM/DD/YYYY)
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 08/29/2008
•
PRODUCER
Aon Risk Services Southwest, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
fka Aon Risk services of Texas, Inc. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
1330 Post Oak Blvd. CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Suite 900 COVERAGE AFFORDED BY THE POLICIES BELOW.
Houston TX 77056-3089 USA

INSURERS AFFORDING COVERAGE NAIC#
PHONE-[phone] FAX [phone]
INSURED INSURER A: National Union Fire Ins Co of Pittsburgh 19445,
GCC Energy, LLC INSURER B: Liberty Insurance underwriters
Inc 19917
4424 County Road 120 ,
.
Hesperus CO 81326 USA
INSURER C:
INSURER D:
INSURER E:
CON FRA,CES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQU]REMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
INSR
LTR ADD'
INS
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION

LIMITS
DATE(MM\DD\W) DATE(MM\DD\YY)
A GENERAL LIABILITY GL4807161 09/01/08 09/01/09 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $50,000

CLAIMS M PREMISES (Ea occurence)
ADE ? OCCUR MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $1,000,000
?

GENERAL, AGGREGATE $2,000,000
'
GEN
L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
$2,000,000
? POLICY ? PRO- E]
LOC
JECT
A AUTOMOBILE LIABILITY CA4806652 09/01/08 09/01/09 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY
X SCHEDULED AUTOS ( Per person)
X HIRED AUTOS
BODILY INJURY
NON OWNED AUTOS (Per accident)
R
41000 Coll Ded
PROPERTY DAMAGE
51000 Comp Ded (Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
e ANY AUTO OTHER THAN EA ACC
-
AUTO ONLY
AGG
B EXCESS /UMBRELLA LIABILITY LQ1B71183565054 09/01/08 9 O1 09 EACH OCCURRENCE ,

El OCCUR ? CLAIMS MADE AGGREGATE $10,000,000
Products/Completed o
-- $10,000,000
- -- --

- -
-- DEDUCTIBLE-- -
- _ _ - ---
B
-,?_ ----^?
--? == -.
? _.,--_.._ _
RETENTION
A
WORKERS COMPENSATION AND wC7208638 1 X WC STATU-
TRY 0TH-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $1,000,000
If yes, describe under SPECIAL PROVISIONS E.L. DISEASE-POLICY LIMIT $1,000,000
below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEFHCL.ES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
See Attached:
i
i
CERTIFICATE HOLDER CAI CELLA TION ;
Colorado Division Of Reclamation, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Mining & Safety DATE THEREOF, THE ISSUING INSURER WILL ENBEAV9&TG MAU,
1313 Sherman street, Room 215 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1
?
1
:
E
Denver CO 80203 USA BUT F;
JL6
RE
Fo I)() S() 911,ki.6 !MPOSE NO OBLIGATION OR EAABR-
fy
??ER
ITS AGENTS OR
,

AUTHORIZED REPRESENTATIVE
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