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v/ 10-MAY-200T 04:59PM FROM-Blanchard Insurance/HUB InternationalSW 9702458016 T-747 P•004/005 F-524 <br />Yp ID UAIC(MWUYYITTTTI <br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE s>;MCO-1 05 10 07 <br />PRODUCER THIS CERTIFICATI- IS ISSUED AS A MATTER OF INFORMATION <br />HUB International Southwest ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Blanchard insurance Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENO OR <br />P.O. Box 60130 ' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Grand Junction CO 81506 <br />Phoue:970-245-8011 Fax:970-245-8016 INSURERS AFFORDING COVERAGE NAIC0 <br />INSURED w INSURERA: Fa1A 10 ea9 Mutual Qasualt C <br />INSURER B: <br />SEM Cons ruction Co. +INSURERC; <br />627 24 1 2 Rd, TTnit I INSURFAD; -- <br />Grand Junction CO 81505 wsuaERE: <br />COVERAGES <br />THE POLICIES or <br />Y CONTRACT OR 07HEA OOCUMENT WRH ABOVE REsPECT TO WHICH YHIS CERTIFICATE MAY E ISSUED OR - • <br />O <br />T 7 <br />RM OR CONDITION <br />F AN <br />ANY REQUIREMEN <br />ICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS of SUCH <br />Y THE PO <br />L <br />MAY PERTAIN, THE INSURANCE AFFORDED B <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCFD BY PAID CLAIMS. <br />IRA <br />IT MIROW ITR N R TYPE INSURANCE POLICY NUMBER ATE MMJDOIYY QA M PP LIMITS <br /> <br />000 <br />000 <br />CE S 1 <br />GENERAL LIABILITY <br />A X COMMERCiALGCNERALLIABILITY 9X90868 05/10/07 05/10/OB EACHOCCURRGN <br />PREMISESEaawwrence) , <br />, <br />$1001000 <br />CLAIMS MADE FX OCCUR MED EXP (Any one person) $S,000 <br /> PERSONAL&A13VINJURY $ 1 000, 000 <br /> GENERAL AGGREGATE _S2 000,000 <br /> w_0 UCTS.COMPrOPAGG s2,0009000 <br />GEN'LAGGREGATE LIMIT APPLIES PER <br />POLICY 71 "' LOC <br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT <br />(Eaertldenu $1,000,000 <br /> 9X90868 05/10/07 05/10108 <br />A X ANYAUro <br /> Au. OWNM AUTOS ROPILY INJURY <br />erson) <br />(P <br />r g <br /> Utos <br />• a <br />p <br /> 6CHEDULFDA <br /> - X HIRED AUTOS BODILY INJURY <br />(Per mcidann $ <br /> EO <br />TOS <br /> X AU <br />NOWOWN <br /> PROPERTY DAMAGE <br />Pe <br />ide <br />t y <br /> n <br />) <br />( <br />r w <br /> AUTO ONLY • EA ACCIDENT S <br /> GA RAGE LIABILITY HERTHAN EAACC <br />O $ <br /> ANY AUTO T <br />AUTO ONLY: AGG S <br /> LALIABIUTY EACH OCCURRENCE S - <br /> EICCESS/UMBREL <br />EICLAIMS MADE AGGRRGATE R <br /> OCCUR <br /> 5 <br /> E S <br /> DEDUCTIBL -- 3 <br /> RETENTION S I H- <br /> TION AND TORY LIMIT6 <br /> WORKERS COMPENSA <br />EMPLOYERS' LIABILITY •?, <br />E.L. EACH ACCIDENT <br />$ <br /> ANY PROPRIETORMARYNERIEXECUTN6 <br />OFFICENMEMPER EXCLUDED? <br />E,L. DISEASE - EA EMPLOYEE <br />S <br /> II yyees. deearlpe under <br />E,4 DISEASE • POLICY LIM11' <br />; <br /> SPG C IAL PROVISIONS nalow <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <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 Daye Notice Due <br />to Non-Payment Of Premium.**Or incur (substantive changes or failure to <br />renew. <br />ceFZTIFIGATE MULUCK •• •••_•._•?...- . <br />6HOUL0 ANY OF THE ABOVE DESCRIBED PCUCIES BE CANCELLED BEFORE THE EXPIRATION <br />0 0 0 0 0 0 0 <br />of Colorado DATE THEREOF, THE ISSUING INSURER WILL Bi =MAIL *30 DAYSWRITTEN <br />state <br />Division of Minerals & Geology NOTICE TO THECR"FICATENOLDERNAMED TOTHELEFT. BUT AL,V <br />1313 Sherman Street Room 215 6"' 1www-M, <br />Denver CO 80203 <br /> <br /> AUTHORIZED REPRESETATIVE <br /> Vir ins KO=1%1ut <br /> ra, wr wti ngldA ATIAIJ 1996 <br /> <br />ACORD 25 (20011UU) /