2011-06-17_GENERAL DOCUMENTS - C1981022 (2)

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A?ORL7 CERTIFICATE OF LIABILITY INSURANCE I 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 22 Lakeview Avenue 2 PHONE (866) 283-7122 FAX (847) 953 -5390 suite 510 West Palm Beach FL 33401 USA A,101 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich American Ins Co 16535 Oxbow Mining, LLC A\ \ G\a c \ a+ 1601 l INSURER 8: Forum P ace \ Suite 1400 J.°??'pd5 INSURER C: West Palm Beach FL 33401-8101 USA 06a INSURER D: r, INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570042757770 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 INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF M/DD/YYYY M POLICY P MMIDDIYYYY IMITS A GENERAL LIABILITY GLO - EACH OCCURRENCE $1,000,000 General Liablity DAMAGE TO RENTED $1 000 000 X COMMERCIAL GENERAL LIABILITY SIR applies per policy ter ns & condit ions PREMISES Ea occurrence , , CLAIMS-MADE X? OCCUR MED EXP (Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 X POLICY PE LOC - A AUTOMOBILE LIABILITY BAP 9265950-01 06/01/2011 66/01/2012 COMBINED SINGLE LIMIT $1 000 000 B i A bil c t Ea accident , , us ness u omo e over X ANY AUTO BODILY INJURY ( Per person) ALL OWNED SCHEDULED UTOS BODILY INJURY (Per accident) AUTOS A PROPERTY DAMAGE HIRED AUTOS NON-OWNED AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB H CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY ' TORY LIMITS ER YIN ANY PROPRIETOR / PARTNER, EXECUTIVE ? N/A E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L. DISEASE-FOLIC L MI DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Elk Creek Mine, Permit #1981-022. certificate Holder is included as Additional insured / Loss Payee ATIMA with respect to Physical Damage to covered autos. CERTIFICATE HOLDER CANCELLATION `m c m d O 2 0 r r vri n 7 0 t- uO O Z a) M R U a) U 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 Reclamation, Mining AUTHORIZED REPRESENTATIVE and safety 1313 Sherman Street , Room 215 Denver JNQ'o%A a c % „ )rDicp ?G,O iEtda CO 80203 USA GI!?.(lQClJ 7161 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD