2011-03-10_GENERAL DOCUMENTS - C1981018

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OP ID: ZO .4CORO' `.? CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 01/05!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 CONTACT NAME: Hays Companies 612-373-7270 PHONE FAX o Ext : AIC No C. 80 South 8th Street #700 Mi li MN 55402 E L ADDRESS: nneapo s, Steve E. Verbeski PR ODUCER CUSTOMER ID #: DESER-3 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Deseret Generation 8r INSURER A: Liberty Mutual Insurance Co 23043 Transmission INSURER B : Attn: Robert Dailey 1 714 S h J d G t INSURER C or an a eway 0 out South Jordan UT 84095 INSURER D: , INSURER E : INSURER F : nr1VIPII C9=RT19:Ir`AT5= NIIMRFR• RFVIRIr1N NIIMRFR- 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MMIDDfYYYY) POLICY EXP MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENERAL LIABILITY T61-641-436749-020 12/30/10 12/30111 PDAMAGE TO RENTED REMISES Ea occurrence $ 2,000,00 CLAIMS-MADE FXIOCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 2,000,00 X EBL$1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRO LOC $ AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ A - - - - --- - - - - - TIBLE_ - $ RETENTION $ - $ WORKERS COMPENSATION WC STATU- 7 AND EMPLOYERS' LIABILITY TORY LIMITS ER Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE N / A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Re: Deserado Mine in Rangely, Colorado (Permit #C-81-018). CERTIFICATE HOLDER CANCELLATION State of Colorado Division of Reclamation, Mining & Safety 1313 Sherman Street Room 215 Denver, CO 80203 COLSTAI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD