2011-09-06_GENERAL DOCUMENTS - C1981035

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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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DDmYY( POLICY EXP 'MM/DD/YYYY) LIMITS B GENERALLIABILITY GL0655124102 09 /01/2011 69/01/2012 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR DAMAGE 10 RENIED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X 1 POLICY n Fa n LOC PRODUCTS - COMP /OP AGG $4,000,000 B AUTOMOBILE UABIUTY BAP 6551242 - 02 09/01/2011 09/01 /2012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X — — ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS $1000 Cell Ded — _ _ SCHEDULED AUTOS NON -OWNED AUTOS $1000 Comp Ded BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) C X _, UMBRELLALIAB EXCESS UAB X OCCUR CLAIMS -MADE UMBSF1875771 09/01/2011 09/01/2012 EACH OCCURRENCE $25,000,000 AGGREGATE $25,000,000 DED I (RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N / A WC655124002 09/01/2011 09/01/2012 X I TORY LIMBS I IOT Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) U U /,� r,� VE See Attached: II V� I L�� Re: OSM Permit C0-0106; CDRMS Permit CO- 1981 -035. SEP 0 6 2011 Division of Re I amatinr ACO/?O CERTIFICATE OF LIABILITY INSURANCE `"His Cl:"RtIFICi4TE IS1gSOED - AS . A MATTER - OF 'MFCIRMATIOFI ONLY'`A)th ONFERS - N() (RIGHTS JPOWTHE CE127iFrCATE 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 Aon Risk Services Southwest, Inc. Houston. TX Office 5555 San Felipe Suite 1500 Houston TX 77056 USA INSURED GCC Energy, LLC 4424 County Road 120 Hesperus CO 81326 USA CONTACT NAME: PHONE (866) 283 - 7122 INC. No. Est): FAX No.): (847) 953 - 5390 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A: American Guarantee & Liability Ins Co INSURERS: Zurich American Ins Co INSURER C: Liberty Insurance underwriters, Inc. INSURER D: INSURER E: INSURER F: DATE(MM/DD/YYYY) 08/31/2011 NAIC # 26247 16535 19917 COVERAGES CERTIFICATE HOLDER ACORD 25 (2010/05) CERTIFICATE NUMBER: 570043660483 CANCELLATION REVISION NUMBER: lldIUiing a Safety ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Colorado Division of Reclamation, Mining & Safety 1313 Sherman Street, Room 215 Denver Co 80203 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE