2011-09-12_GENERAL DOCUMENTS - C1984063

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DATE (MMIDD/YYYV) ACCOR V CERTIFICATE OF LIABILITY INSURANCE 9/61 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�,equire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER John L. Wortham & Son L.P. " CONTACT NAME P. O. Box 1388 PHONE • 713- 526 -3366 A/c No) 713 - 521 -1951 Houston, TX 77251 -1388 p 5�,1 E -MAIL ADDRESS: ' �w �R •� G\ I N� r, 'Z, >� INSURER (S) AFFORDING COVERAGE NAIC # Ox` ✓� �v;+ INSURER A: St. Paul Fire and Marine Insurance Company 24767 INSURED Abraxas Petroleum Corporation ` :;��; 1 � INSURERB: 18803 Meisner Drive INSURER C: San Antonio TX 78258 INSURER D: INSURER E INSURER F: ___rnVFRAGES . ----r- - CERTIFICATE NUMBER:- 11069607 - -- — - -- ___REVISION NUMBER:__ olnn THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR A IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY PERTAIN, AND CONDITIONS OF SUCH TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FZ/ OCCUR OF INSURANCE POLICIES. ADDL �/ SUBR �I LISTED BELOW HAVE bttN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN REDUCED POLICY NUMBER VK04210983 IJAUtU I U CONTRACT THE POLICIES BY POLICY EFF IM Ml 9/1/2011 1 nt nNOul OR OTHER DOCUMENT DESCRIBED PAID CLAIMS. POLICY EXP MMIDDIYYYY 9/112012 v 1..,. - --- -- • � - • -- - - - WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 A �/ VK04210983 9/1/2011 9/1/2012 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- v POLICY LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED e SCHEDULED - AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS `/ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB H CLAIMS-MADE DED RETENTION $ $ WORKERS COMPENSATION 7H TORY LIMITS O ER E�Z-EACHACCIDENT - " '- -$ -- - " - "—` - _ AND EMPLOYERS' LIABILITY YIN_ ANY PROP RIETOR/PARTNER/EXECUTIVE (�"� E.L. DISEASE - EA EMPLOYEE $ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N/A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate Holder is included as an additional insured and a waiver of subrogation is provided under the General Liability and Automobile Liability policies when required by written contract (executed prior to a loss) but only as respects to liability arising out of the named insured's work for the additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Division of Minerals and Geology THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Mr. Byron Walker ACCORDANCE WITH THE POLICY PROVISIONS. 1313 Sherman Street AUTHORIZED REPRESENTATIVE Denver CO 80203 John L. Wortham & Son, L.P. Wile A Tl^Ll All.: wM4- ecn-A ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 11069607 CLIENT CODE: 10ABRAXPET (HOU) Lillian Wright 9/6/2011 9:37:17 AM Page 1 of 2