2009-06-01_GENERAL DOCUMENTS - C1981019

• Permit No: C1981019
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 6/1/2009
• Doc Name: Certificate of Insurance
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: JRS
• Media Type: D
• Archive: No

CERTIFICATE OF` INSURANCE
'W ISSUE DATE:
ORM) 5/29/09
PRODUCER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND

Wells Fargo of California Insurance Services, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER OTHER COVERAGE AFFORDED BY THE

45 F
S POLICIES BELOW.
remont
treet, Suite 800
COMPANIES AFFORDING COVERAGE
San Francisco CA 94105 ?, 1 COMPANY Zurich American Insurance Company
®
CA DOI License #0352275
e LETTER A
9. COMPANY Insurance Company of the State of PA
phone: [phone] fax: [phone] TO LETTER B
INSURED:
-'amak" ,
ETTER cY Insurance Company of the State of PA
`
tl L
d sa{0
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C COMPANY
o
owyo Coal Company, L.P. Di.IIM
9 an ETTER
16n L
5731 State Highway 13 COMPANY
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k
CO 81641 LETTER E
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er
COVERAGES AND LIMITS
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABUVE FOR THE POLICY PERIOD INDICATED
,
NOTbVITHSTANDING 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. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO. TYPE OF INSURANCE POLICY NUMBER POLICY EFF. POLICY EXP. DESCRIPTION LIMITS
LTR DATE DATE
A GENERAL LIABILITY GL08249662-00 5/31/2009 5/31/2010 GENERAL AGGREGATE $ 2,000,000
Ex I COMM. GENERAL LIAB. PROD-COMP/OP AGG. $ 2,000,000
7 CLAIMS MADE PEAS & ADV. INJURY $ 2,000,000
F I OCCURRENCE EACH OCCURRENCE $ 2,000,000
? OWNER'S & CONTRACT'S PROT FIRE DAMAGE (One Fire) $ 100,000
MEDICAL EXPENSE (One Per) $ 5,000
B AUTOMOBILE LIABILITY CA7204495 5/31/2009 5/31/2010
F-1 ANY AUTO COMBINED SINGLE LIMIT
$ 1,000,000
ALL OWNED AUTOS BODILY INJURY (Per Person)
? SCHEDULED AUTOS BODILY INJURY (Per Accident)
? HIRED AUTOS PROPERTY DAMAGE
NON-OWNED AUTOS
GARAGE LIABILITY

EXCESS LIABILITY EACH OCCURRENCE
? UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM
C WORKERS'COMPENSATIONAND WC7208192 5/31/2009 5/31/2010 STATUTORY LIMITS
EMPLOYER'S LIABILITY EACH ACCIDENT $ 1,000,000
DISEASE - POLICY LIMIT $ 1,000,000
DISEASE - EACH EMPLOYEE $ 1,000,000
OTHER INSURANCE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS:
Re: Mining Permit C-81-019, See Attached Addendum.
NAME AND ADDRESS OF CERTIFICATE HOLDER: 110 CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION

Colorado Division of Reclamation Minin
and Safet DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS WRITTEN NOTICE TO THE
g
y CERTIFICATE HOLDER NAMED TO THE LEFT.
athl: James Stark AUTHORIZED REPRES ATI . "
1313 Sherman Street, 215 Centennial Building
Denver CO 80203
Rio Tinto Certificate 0910 - UT090109:5/29/2009