|
CERTIFICAT IA.
<br />PRODUCER
<br />Aon Risk services southwest, Inc.
<br />Houston Tx office SE P
<br />Post Oak Blvd. SCP , ,
<br />suite 900 2009
<br />Houston Tx 77056-3089 USA 01V1b1Iy11 V, +?irCja
<br />PHONE-(866) 283-7122 FAX-(R47) '4'4?L16R?A 1 - ma
<br />INSURED
<br />GCC Energy, LLC
<br />4424 County Road 120
<br />Hesperus Co 81326 USA
<br />COVRRAGRC
<br />C C(? I C 'DIs
<br />[LITY INSURANCE DATE
<br />Y?
<br />08/27/2009
<br />'HIS, CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
<br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
<br />COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />
<br />rNSURERA: Zurich American Ins Co 16535
<br />
<br />INSURERB: Liberty insurance underwriters, Inc.
<br />19917 fr
<br />h
<br />r
<br />INSURER C: aqi
<br />b
<br /> H
<br />INSURER D: i.
<br />d
<br /> O
<br />INSURER E: p
<br /> x
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
<br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRII3ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
<br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
<br />INSR ADD'
<br />LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
<br /> DATE(MMIDDNYYY, DATE(MM/DD[YYYY)
<br />A ERALLIABILITY GL0655124100 09/01/2009 09/01/2010 EACH OCCURRENCE $2,000,000
<br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1,000,000
<br /> P - PREMISES (Ea occurrence)
<br /> CLAIMS MADE ? OCCUR MED EXP (Any one person) $10,000
<br /> PERSONAL & ADV INJURY $1,000,000
<br /> EJ
<br /> GENERAL AGGREGATE $4
<br />000
<br />000
<br /> G EN'L A
<br />RE ,
<br />,
<br /> GATE LIMIT APPLIES PER:
<br />GG
<br />PRODUCTS - COMP/OP AGG
<br />$4,000,000
<br />
<br />?
<br />?X POLICY ? PRO- LOC
<br /> JECT
<br />A AUTOMOBILE LIABILITY BAP655124200 09/01/2009 09/01/2010
<br /> COMBINED SINGLE LIMIT
<br /> X ANY AUTO (Ea accident) $1,000,000
<br /> ALL OWNED AUTOS
<br /> BODILY INJURY
<br /> SCHEDULED AUTOS ( Per person)
<br /> HIRED AUTOS
<br /> BODILY INJURY
<br /> NON OWNED AUTOS (Per accident)
<br /> $1000 Coll Ded PROPERTY DAMAGE
<br /> $1000 COmD Ded (Per accident)
<br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
<br /> ANY AUTO
<br /> H OTHER THAN EA ACC
<br /> AUTO ONLY
<br /> AGG
<br />B EXCESS/UMBRELLA LIABILITY LQ1B71183565064 09/01/2009 09/01/2010 EACH OCCURRENCE 10,000,000
<br /> OCCUR ? CLAIMS MADE AGGREGATE $10,000,000
<br /> Products/Completed 0 $10,000,000
<br />
<br /> DEDUCTIBLE
<br /> _- `---,-.-?
<br />---•?..
<br /> ..
<br />RETENTION_?- ___. _ _.._. x__ _._?_ -._ ,_ .-. T _? __ ?.
<br />A wc65S124000 09/01/2009 X WC STATU- OTH-
<br /> WORKERS COMPENSATION AND
<br />
<br />'
<br />Y / N
<br />TORY LIMIT
<br />ER
<br /> EMPLOYERS
<br />LIABILITY
<br />N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $2,000,000
<br /> OFFICER/MEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $2,000,000
<br /> (Mandatory in NH)
<br /> E.L. DISEASE-POLICY LIMIT $2,000,000
<br /> ]f es, describe under SPECIAL PROVISIONS below
<br /> OTHER
<br />DESCRIPTION OF OPERATIONS/LOCATIONSNEMCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
<br />See Attached:
<br />m
<br />r\
<br />O
<br />6l
<br />rn
<br />m
<br />O
<br />O
<br />n
<br />O
<br />z
<br />O
<br />U
<br />w
<br />i.,
<br />a
<br />U
<br />ti•
<br />CERTIFICATE HOLDER CANCELLATION
<br />Colorado Division Of Reclamation, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ¦
<br />mining & safety DATE THEREOF, THE ISSUING INSURER WILL RNPR '^n TO MAIL
<br />1313 Sherman street, Room 215 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />Denver Co 80203 USA B?44: FULURFTO DO 80 8Ihkh1= 1? !POSE NO OBLIGATION OR LIAB11ATY
<br />,,a„ 4DUPONTHEP481PR-R,!TSAGE s =?
<br />AUTHORIZED REPRESENTATIVE ?y t%O? Jsoevcrr7 e7w?Lfaicr?isa
<br />ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved
<br />The ACORD name and logo are registered marks of ACORD
|