2011-01-11_GENERAL DOCUMENTS - C1981018

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OP ID: ZO ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01105/11 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 612-333-3323 TACT NAME : Hays Companies 612-373-7270 PHONE A/C No : 80 South 8th Street #700 E-MAIL Minneapolis, MN 55402 ski rb St E V PRODUCER CUSTOMER ID#: DESER-3 eve . e e INSURER(S) AFFORDING COVERAGE NAIC # INSURED Deseret Generation & INSURER A : Liberty Mutual Insurance Co 23043 Transmission INSURER B : Attn: Robert Dailey INSURER C 10714 South Jordan Gateway UT 84095 th J d S INSURER D : an, or ou INSURER E : INSURER F : Ift A^'-n 15TIG10+ATG \11111AQGD. RFVIRICIN NIIMRFR- vTHIS 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY YYEFF YY YYY MM/DDIDN LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENERAL LIABILITY TB1-641-436749-020 12/30/10 12/30/11 DAMAGE TO RENTFD PREMISES Ea occurrence $ 2,000,00 CLAIMS-MADE a OCCUR MED EXP (Any one person) $ 10,00 ? PERSONAL & ADV INJURY $ 2,000,00 X EBL $1,000,000 ``'' r /??`Y Y© GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: ? V PRODUCTS - COMP/OP AGG $ 2,000,00 PRO + $ LOC POLICY AUT OMOBILE LIABILITY \ A aS1+ COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO d gate?N 1S?u++ "' e BODILY INJURY (Per person) $ ALL OWNED AUTOS n ??V BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS F-1 I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ -- - - - - - - - - ATU-- TH WCS? - WORKERS COMPENSATION R IMI TRY L AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y EACH ACCIDENT E.L. $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Deserado Mine in Rangely, Colorado (dermit#C-81-018). GERTIPIGAIt HULULK vI+1\vGVV+11v1. COLSTA1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN State of Colorado ACCORDANCE WITH THE POLICY PROVISIONS. Division of Reclamation, Mining & Safety AUTHORIZED REPRESENTATIVE 1313 Sherman Street Room 215 Denver, CO 80203 V 1V0tf-LUUV A%.VRU ?IVRrUMMI IV19. H11 r191IL* 1Ci.7C1v17U. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD