2011-06-17_GENERAL DOCUMENTS - C1983059

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?1 ® ACRD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/06/2011 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 Services, Inc of Florida FAX (847) 953-5390 (866) 283-7122 O N 222 Lakeview Avenue ( (A/C . No.Ext): No.): Suite 510 E-MAIL west Palm Beach FL 33401 USA ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: American Guarantee & Liability Ins Co 26247 Oxbow Mining, LLC 1601 Forum Place INSURER B: suite 1400 INSURER C: west Palm Beach FL 33401-8101 USA INSURER D: INSURER E: INSURER F: COVFRAGFS CERTIFICATE NUMBER- 570042757810 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 LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDNYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMA7E TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence CLAIMS-MADE ? OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG P R E O- LOC POLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY ( Per person) ALL OWNED SCHEDULED A T BODILY INJURY (Per accident) AUTOS HIRED AUTOS U OS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR UMB926593701 06/01/2011 06/01/2012 EACH OCCURRENCE $2S,000,000 EXCESS LIAB CLAIMS-MADE umbrella SIR a lies er olic ter ns & condi ions AGGREGATE $25,000,000 pp p y p DED X RETENTION $10,000 WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY TORY LIMITS ER Y I N ANY PROPRIETOR / PARTNER, EXECUTIVE ? N /A E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL. DISEASE-EA EMPLOYEE - It yes describe under - - DESGR5FTRYWOF OPt a De ow c c DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Terror creek company. C-1983-059. Division of Reclamation, mining & safety is named as an Additional Insured excluding workers' Compensation and Employers' Liability as required by written contract but limited to the operations of the insured under said contact, and always subject to the policy items, conditions and exclusions. O 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. Division of Recl amati OTi?? Q'? ` ?a5 AUTHORIZED REPRESENTATIVE mining & 1313 Sherman street Room 215 Denver Co 80203 USA \ c flan `j?fC c/?LtYee4 e/na ??Gsu?a ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD d C N N v O S 0 m rl- r N cD 0 0 uo O Z N t6 -E d U f_ Z' 1 ?y a-a - ?a f-