2012-01-03_GENERAL DOCUMENTS - C1981018

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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 SUER INSR wvn POLICY EFF POLICY EXP POLICY NUMBER (MM /DD/YYYY) (MM /Y /DDYVY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR INSURED Deseret Generation & Transmission Attn: Robert Dailey 10714 South Jordan Gateway South Jordan, UT 84095 INSURER A• LIBERTY MIIT INS CO TB1 641 - 436749 - 021 12/30/11 12/30/12 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 2,000,000 INSURER E : CLAIMS -MADE MED EXP (Any one person) $ 10, 000 PERSONAL &ADV INJURY $ 2,000,000 GEN'L X GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER POLICY PRO- LOC IFC:T PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED') (Mandatory in NH) Ii yes, descnbe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES Re: Deserado Mine in Rangely, Colorado (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE C EIVED (Permit #C -81 -018). JAN 0 3 701? Do/ism u ul rwelamatIOn, &a:e:....... -1 C -.fnh, State of Colorado Division of Reclamation Mining & Safety 1313 Sherman Street Room Denver, CO 80203 I 215 USA 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 AW ©® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/28/2011 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 require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1 - 612 - 333 - 3323 Hays Companies 80 South 8th Street Suite 700 Minneapolis, MN 55402 CONTACT NAME: PHONE 612 - 333 - 3323 FAX 612 - 373 - 7270 (_AIC. No. Eat): (A/C, No): E ADDRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Deseret Generation & Transmission Attn: Robert Dailey 10714 South Jordan Gateway South Jordan, UT 84095 INSURER A• LIBERTY MIIT INS CO 23043 INSURER B' INSURERC: INSURER D : INSURER E : INSURER F : COVERAGES kpsimos ACORD 25 (2009/09) 24685801 CERTIFICATE HOLDER CERTIFICATE NUMBER: 24685801 CANCELLATION REVISION NUMBER: © 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD