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AGENCY CUSTOMER ID: 570000036509 <br />LOC ##: <br />Page 1 of 1 <br />A ° ADDITIONAL REMARKS SCHEDULE <br />AGENCY <br />Aon Risk services, Inc of Florida NAMEDINSURED <br />oxbow carbon & Minerals, LLC <br />POLICY NUMBER <br />see certificate Number: 570042757839 <br />CARRIER NAIC CODE <br />Pee Certificate Number: 570042757839 EFFECTIVE DATE <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />Additional Description of Operations / Locations / Vehicles: <br />Commercial General Liability covers use of explosives. <br />Division of Minerals & Geology is named as an Additional Insured excluding workers' Compensation and <br />Employers' Liability as required by written contract but limited to the operations of the Insured under said <br />contract, and always subject to the policy terms, conditions and exclusions. <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD