2010-12-06_GENERAL DOCUMENTS - C2010088

• Permit No: C2010088
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 12/6/2010
• Doc Name: Certificate of Liability Insurance
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: MPB
• Email Name: SB1
• Media Type: D
• Archive: No

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?`4 z° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)

11 /23/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the
terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Aon Risk insurance services West, Inc. [phone]
[phone] A/
("
Fresno CA Office C. No.):
VC... Ext):
5260 North Palm Avenue E-MAIL
suite 400
Fresno cA 93704 USA F> PRODUCER 570000031836
CUSTOMER ID III:
?WIV INSURER(S) AFFORDING COVERAGE NAIC #
INSURED flE9 INSURER A: National Union Fire Ins Co of Pittsburgh 19445
CAM-Colorado LLC ry qq
1169
O `O INSURER B:
P.O. Box
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Pikeville KY 41502 USA v "\, INSURER C:

INSURER D:
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COVERAGES CERTIFICATE NUMBER: 570040862829 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
IN SR
LTR TYPE OF INSURANCE ADD
INSR UBR
WVD POLICY NUMBER POLICY FF
MM/DD P LI Y EXP
MMroD LIMITS
A GENERAL LIABILITY GL 045 12/01/2010 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY E RENTED
PRREMI EMISES S Ea occurrence) $1,000,000
X? OCCUR MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000 N
GENERAL AGGREGATE $2,000,000 m
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 v
POLICY PRO- X LOC o
A AU TOMOBILE LIABILITY cA0935830 12/01/2010 06/01/2012 COMBINED SINGLE LIMIT
$1
000
000
Ea accident ,
,
X ANY AUTO BODILY INJURY ( Per person) Z
ALL OWNED AUTOS BODILY INJURY (Per accident) d
SCHEDULED AUTOS PROPERTY DAMAGE ni
v
Per accident
X HIREDAUTOS
:E

X
TOS d
NON OWNED AU t1
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAR CLAIMS-MADE AGGREGATE
DEDUCTIBLE
RETENTION
WORKERS COMPENSATION AND _
OR
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EMPLOYERS' LIABILITY T
Y
I
R
Y / N
ANY PROPRIETOR / PARTNER / EXECUTIVE
E.L. EACH ACCIDENT
?
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L. DISEASE-EA EMPLOYEE
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE-POLICY LIMIT

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
RE: Unit Train Loadout
state of r_olorado, Division of Reclamation mining & safety is included as Additional Insured.
*Except 10 days notice for non-payment of premium. -

CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
State of Colorado AUTHORIZED REPRESENTATIVE
Division of Reclamation Mining & Safety
1313 Sherman St. Rm #215.-/?
Denver CO 80203 USA
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©1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD