2009-01-26_GENERAL DOCUMENTS - C1981015

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a it ACORDCERTIFICATE OF LIABILITY INSURANCE 1/22i2o 9' PRODUCER (970)243-3421 FAX: (970)242-1894 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Moody-Valley Insurance Agency, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 1509 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Grand Junction CO 81502 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Bituminous Insurance Professional Pipeline and Concrete, Inc. INSURER B:Pinnacol Assurance 41190 806 East Pabor INSURER C: INSURER D: Fruita CO 81521 INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, REQUIREMENT , 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. INSR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE MMIDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PR MISES Ea occurrence $ 100, 000 A CLAIMS MADE F_X] OCCUR CLP3258778B 12/15/2008 12/15/2009 MEDEXP An one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY JECT LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT 000 000 $ 1 ANY AUTO (Ea accident) , , A ALL OWNED AUTOS CAP3526079B 12/15/2008 12/15/2009 BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Mobile Eq-road use PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 X OCCUR 1-1 CLAIMS MADE AGGREGATE $ 1,000,000 A DEDUCTIBLE CUP2583730B 12/15/2008 12/15/2009 $ X RETENTION 10,000 Excess of GL & BA Only B WORKERS COMPENSATION AND X WC STATU I TORY EE EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100,000 OFFICER/MEMBEREXCLUDED? 4055960 5/1/2008 5/1/2009 E.L. DISEASE - EAEMPLOYEE $ 100,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500 , 000 A OTHER Leased/Rented CLP3258778B 12/15/2008 12/15/2009 $200,000 per item Equipment $400,000 max $1,000 deductible DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Re: Project No.: PKA-9-1149, Fruits Mine Bond Revocation - Bid Date: January 27, 2009. A 10-day notice of cancellation will apply in the event of non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I State of Colorado, Department of Natural EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Colorado Division of Reclamation & Mining 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 1313 Sherman Street, Room 215 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Denver, CA 80203 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE C? N Jordan, CRIS/NANJOR?? 2 a ACORD 25 (2001/08) © ACORD CORPORATION 1988 INS025 (0108p8a Page 1 of 2