2011-09-20_GENERAL DOCUMENTS - C1981047

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VUV CIIHUCJ vr.�... .vr.. .........�,.. 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. L R TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMA /DD (MM /DDYIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X 3X6490412 09/01/2011 09/01/2012_ OCCURRENCE $1,000,000 $100,000 poACH PREMISES oNcurrence) MED EXP (Any one person) $5,000 $1,000,000 CLAIMS -MADE 1 XI OCCUR PERSONAL & ADV INJURY GENERAL AGGREGATE $2,000 000 PRODUCTS - COMP /OP AGG $2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PER JE n LOC $ A- AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON AUTOS -OWNED X 3X6490412 09/01/2011 09/01/2012 C OMBINED IT (Ea accdent) SI ' NGLE LIM- j 1,000,000 -- — BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Par accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) dyes, describe under DESCRIPTION OF OPERATIONS below Y / N N ! A WC STATU- OTH- TORY I IMITS FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS ! LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Blue Ribbon Mine - File No C- 81 -047. State of Colorado, Division of ?„ N Minerals & Geology is included as Additional Insureds.30 days notice of „ s n Z. `t � cancellation is provided. ` Client#: 123725 SBHOLDIN1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE 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 Grand Junction, CO 81506 970 245 -8011 INSURED Minrec Inc 627 241 /2 Rd Unit H Grand Junction, CO 81505 CONTACT Anita ta Keller PHONE 970 - 245 -8011 (ANC, No, Ext): FA/CAX , No): 866- 908 -6374 ( ADDRESS: anita .keller @hubinternational.com INSURER(S) AFFORDING COVERAGE INSURERA: Employers Mutual Casualty Compa INSURER B : INSURER C : INSURER D : INSURER E INSURER F : CA Resident License #0757776 I DATE (MM/DD/YYYY) 9/16/2011 NAIC # 21415 CERTIFICATE HOLDER ACORD 25 (2010/05) 1 of 1 #S1317374/M1317106 • CANCELLATION REVISION NUMBER: State of Colorado Division of Minerals & Geology 1313 Sherman St, Room 215 Deriver, CO 80203 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 2-et . ✓')a e. u4I © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DCO2