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PRODUCER <br />MCGRIFF, SEIBELS & WILLIAMS, INC. <br />INSURED <br />American Electric Power Company, Inc. and all Subsidiaries <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />ISSUE DATE: 06/27/2012 <br />ACd <br />ADDITIONAL REMARKS <br />AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER FORM TITLE: <br />(continued from previous page) <br />Notice of Cancelation: <br />Name and Address: <br />Colorado Department of Natural Resources <br />Division of Reclamation, Mining and Safety <br />1313 Sherman Street, Room 215 <br />Denver, CO 80203 <br />Number of days: 30 <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD CERTIFICATE NUMBER: UPPB3Q4T <br />