2011-07-22_GENERAL DOCUMENTS - C1984065

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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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY INSURED JUL 2011 C.B. Minerals Company, LLC U lvi � l � �� r{eClamation, PO Box 1827 Mining and Safety Pebble Beach, CA 93953 INSURER B : 1 X1 5286 07/12/2011 07/12/2012 EACH OCCURRENCE $500,000 PREMISES Ea occu ence) $100,000 $5,000 MED EXP (Any one person) CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $500,000 X PD Ded:250 GENERAL AGGREGATE $1,000,000 PRODUCTS - COMP /OP AGG $1,000,000 GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO JECT PER: LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS AUUTOSWNED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY a c dent) AMAGE $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WOgk(FRS MneDENSATION I WC-STATU El-TH AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A _ I TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Coal Ridge No. 1 Mine ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDMlYY) 0712112011 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 HUB International Ins Svcs Inc 2742 Crossroads Blvd ��"✓Et t � ® Junction, CO 81506 I 970 245 -8011 2 CONTACT Melissa Jones NAME: PHONE 303 - 382 -5166 Fax 866- 243 -0727 (A/C, No, Ext): (A/C, No): E -MAIL melissa.jones@hubinternational.com melissa'ones hubinternational.com ADDRESS: @ INSURER(S) AFFORDING COVERAGE NAIC # EMC I Companies INSURER A: P 25186 INSURED JUL 2011 C.B. Minerals Company, LLC U lvi � l � �� r{eClamation, PO Box 1827 Mining and Safety Pebble Beach, CA 93953 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : CA Resident License #0757776 COVERAGES CERTIFICATE HOLDER CERTIFICATE NUMBER: CANCELLATION CBMINERA REVISION NUMBER: Division of Reclamation, Mining & Safety 1313 Sherman Street Room 215 Denver, CO 80203 -2273 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 64644* .a . ,) c,4I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD