2010-10-12_GENERAL DOCUMENTS - C1981035

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- ?--h?I--03S DATE(MM/DD/YYYY) -?k___!CERTIFICATE OF LIABILITY INSURANCE 08/25/2010 PRODUCER Inc . Aon Risk services southwest THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY , Houston TX office AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 1330 Post Oak Blvd. CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Suite 900 COVERAGE AFFORDED BY THE POLICIES BELOW. Houston Tx 77056-3089 USA INSURERS AFFORDING COVERAGE NAIC # PHONE-866 283-7122 FAX- 847 -5390 INSURED INSURER A: Zurich American ins Co 16535 GCC Energy, LLC KI 4424 County Road 120 INSURER B: American Guarantee & Liability Ins Co 26247 O Hesperus CO 81326 USA I INSURER C: Everest National insurance Co 10120 00 JA 140 ? INSURER D: C 0 d U INSURER E: O ?,v v ra va..? - - 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 J LTR ADD'14 INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE(MM/DDIVYYY] DATE MM/DD A GENERAL LIABILITY GL0655124101 09/01/2010 09/01/2011 EACH OCCURRENCE $2,000,000 x DAMAGE TO RENTED $1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) CLAIMS MADE ® OCCUR MED EXP (Any one person) ?,6 PERSONAL & ADV INJURY $1,000,000 F] GENERAL AGGREGATE $4,000,000 ' GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 PRO - ? LOC ?X POLICY ? JECT A AUTOMOBILE LIABILITY BAP 6551242-01 09/01/2010 09/01/2011 COMBINED SINGLE LIMIT (Ea accident) 0 $1,000,00 X ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS ( Per Person) HIRED AUTOS BODILY INJURY NON OWNED AUTOS (Per accident) $1000 Coll Ded PROPERTY DAMAGE (Per accident) $1000 Comp Ded GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY : AGO c EXCESS / UMBRELLA LIABILITY 7162000069101 09/01/2010 09/01/2011 EACH OCCURRENCE $10,000,000 El OCCUR ? CLAIMS MADE AGGREGATE $10,000,000 H DEDUCTIBLE - _ _ --- - -- - - - -- - - - -- -- - - -_ - - - - - __ -- . ? . _ --- ? -"- - _ - RETENTION B wC 55 24 1 09 01/2010 x I WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS R EMPLOYERS' LIABILITY X.Lu N E.L. EACH ACCIDENT $2,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE L. DISEASE-EA EMPLOYEE E $2,000,000 OFFICER/MEMBER EXCLUDED? . (Mandatory in NH) E.L. DISEASE-POLICY LIMIT $2,000,000 If es, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS see Attached: n N Ln art C' rn m O O O Zi a?+ e7 u w d U 2 r _• CERTIFICATE HOLDER l.A1Nl LLLAIIVIN Colorado Division of Reclamation, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Mining & safety DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1313 Sherman street, Room 215 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Denver Co 80203 USA )C i9NE) UPON THE OR REPRESENTATIVE-8, p 6 AUTHORIZED REPRESENTATIVE IM.r?? ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved= The ACORD name and logo are registered marks of ACORD