2010-08-31_GENERAL DOCUMENTS - C1984063

• Permit No: C1984063
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 8/31/2010
• Doc Name: Certificate of Liability Insurance
• From: ACE American Insurance Company
• To: DRMS
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

C 1?18?1_n?? sb1
DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
08/31/2010
PRODUCER
Aon Risk services southwest, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Houston TX Office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
5555 San Felipe CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
suite 1500
Houston TX 77056 USA COVERAGE AFFORDED BY THE POLICIES BELOW.

INSURERS AFFORDING COVERAGE NAIC#
PHONE-[phone] FAX-[phone]
INSURED INSURER A: ACE American insurance company 22667 ••
Abraxas Petroleum Corporation w
18803 Meisner Dr. INSURERS:
San Antonio TX 78258 USA INSURER C:

INSURER D:
PC
INSURER E: p
x
COVERAGES
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. LIMITS SHOWN ARE AS REQUESTED
INSR ADD'
LTR INS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
ATE MM/DD DATE(MM/DDNYYY)
A PMDG24652361003 09/01/2010 09/01/2011 EACH OCCURRENCE $1
000
000
GENERAL LIABILITY ,
,
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000
PREMISES (Ea occurrence)
CLAIMS MADE ® OCCUR MED XY (Any one ocrson
'
PERSONAL & ADV INJURY $1,000,000

0 GENERAL AGGREGATE $2
000
000
,
,
GENL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
?X POLICY 11 PRO- ? LOC
JECT
A AUTOMOBILE LIABILITY PMU H084 1340A-003 09/01/2010 09/01/2011
COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
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
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE
? OCCUR ? CLAIMS MADE AGGREGATE

RETENTION
WC STATU- OTH-
WORKERS COMPENSATION AND IMI ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandator
in NH) E.L. DISEASE-EA EMPLOYEE
y E.L. DISEASE-POLICY LIMIT
If es, describe under SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is named Additional Insured as required by written contract with respect to General Liability
and Auto Liability coverages. waiver of Subrogation is included in favor of Certificate Holder with respect to
General Liability and Auto Liability coverages.
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CERTIFICATE HOLDER CANCELLATION
Division of Minerals & Geology SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Attn. Mr. Byron walker DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
1313 Sherman street 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Denver CO 80203 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE I _V. a=/?e_//k- i. -1 -- yea
ACORD 25 (2009/01) 01988-2009 ACORD CORPORATION. All rights reserved=
The ACORD name and logo are registered marks of ACORD