2009-02-18_GENERAL DOCUMENTS - C1980001

• Permit No: C1980001
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 2/18/2009
• Doc Name: 2009 Certificate of Liability Insurance
• From: MARSH Risk & Insurance Services
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: TAK
• Media Type: D
• Archive: No

ACORDCERTIFICATE OF LIABILITY INSURANCE TDATE (MM/DD/YYYY)
2/17/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MARSH RISK & INSURANCE SERVICES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
345 CALIFORNIA STREET, SUITE 1300 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
O. 0437153
®
LI
C
R
IA LICE
E ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
ECE'V?
A
F
N
4
49
R
025158-003-003- 007C INSURERS AFFORDING COVERAGE NAIC #
INSURED Eg CHEVRON MINING, INC.
F ?t tW '?' INSURER A: ACE American Insurance Company 22667
116 INVERNESS DRIVE
1 +K INSURER B:
0
SUITE 207gIOR
ENGLEWOOD, CO 80112?tft9 INSURER C:
INSURER D:
INSURER E:
%lu v anAu ca
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, 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.
NSR
LTR ADD'
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL LIABILITY EACH OCCURRENCE 1.000.000
A X COMMERCIAL GENERAL LIABILITY CMR G2374188A 03/01/09 03/01/10 DAMAGE TO RENTED

PREMISES Ea occurence Is
X CLAIMS MADE F7OCCUR MED EXP (Any one person) $
X RFTRo BATE. MARCH 1 98 PERSONAL & ADV INJURY $ 1
000
00C
,
,
GENERAL AGGREGATE $ 1,0()0
00
,
GENERAL AGGREGATE

LIMIT APPLIES PER
PRO-

PRODUCTS - COMP/OP AG

1,000,00c
POLICY JECT LOC
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: $
AGG
A EXCESS/UMBRELLA LIABILITY XLX G23741908 03/01/09 03/01/10 EACH OCCURRENCE $ 3,500,00
OCCUR CLAIMS MADE AGGREGATE $ 6,500,0()
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYE RS' LIABILITY
Y PR
PR
ET
R/P
RT
E L. EACH ACCIDENT $
AN
I
A
N
R/EXECUTIVE
O
O
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $
If yes, describe under
L
DISEASE -POLICY LIMIT
$
SPECIAL PROVISIONS below .
OTHER
DESCRIPTION OF OPERATION S/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
This Certificate shall provide for personal injury and property damage as a result of surface coal mining and reclamation operations including arising from the
use of explosives at the Insured"s Edna Mine in Colorado. The issuing Company shall notify the below named Certificate Holder whenever substantive
changes are made in the above described policies including termination or failure to renew.
CERTIFICATE HOLDER SEA-001308892-22 CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Division of Reclamation, EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL XXW)iO MAIL
Minerals and Safety 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: Tom Ka ch

1313 Sherman n Street, Room 215 D(J6#?ADCT( C?t3C?OC AC$73?XACA6 fi2(#XD10C ((?GX)6J4D? XX?SkOAQ C#?C?tD(fX{tfD6
Denver, CO 80203-2273 XPMXX-Y"XX)")(KMXXXMXXXMXKXX)CXXX94";+?t XKt .*A
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Wendy Sokol
ACORD 25 (ZUU1/US) O ACORD CORPORATION 1988