2012-09-10_GENERAL DOCUMENTS - C1984065

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4"A'An CBMINERA ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYYI 7123/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ':ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 1ELOW. 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 15 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 CONTACT Melissa Janes NAME: PHA!C ON N E o Ext 303 382 -5166 Arc No ; 866 243 -0727 2742 Crossroads Blvd Grand Junction, CO 81506 E -MAIL ADDRESS: Mel'SSa.jones(?@Phublinternational.com INSURERtS) AFFORDING COVERAGE NAIC# INSURERA: EMC Insurance Companies 25186 888 245 -8011 INSURED C.B. Minerals Company, LLC PO Box 1827 Pebble Beach, CA 93953 INSURER 8 GENL AGGREGATE LIMIT APPLIES PER: INSURER C: $1,000,000 INSURER D INSURER E INSURER F: CA Resident License #0757776 rnvcrsnr_ce C-- FRTIFIC -ATE N I1URFR• REVISION NUMBER: V THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 TYPE OF INSURANCE ADDL 5UBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MWDDffYYY MM22 LIMITS A GENERAL LIABILrrY 1X15286 D711212012 0711212013 OCCURRENCE $500,000 X COMMERCIAL GENERAL LIABILITY p EACH PREM155 Ea accu p nce $100,000 CLAIMS -MADE IJI OCCUR MED EXP (Any are person) $ 5,000 X PDDed:250 PERSONAL &ADVINJURY $500,000 GENERAL AGGREGATE $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $1,000,000 POLICY 7 P ECf Los $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aedden€ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREOAUTOS AUTOS PROPERTY DAMAGE PeraccidenE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS UA13 DI=D RETENTION $ $ WORKERS COMPENSATION WC S7ATU- OTH- FR AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERtEXECUTNE YIN OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E,L, EACH ACCIDENT $ E.L- DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ II yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (Aitaeh ACORD 101, Additional Remarks Schedule, It more space Is required) DMG permit # C84065- Coal Ridge No. 1 Mine, East of New Castle, CO, South of River NCIG Financial Inc. & CO Division of Minerals & Geology are named as additional insured with respects to general liability. Division of Reclamation, Mining SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN & Safety ACCORDANCE WITH THE POLICY PROVISIONS. 1313 Sherman Street Room 215 Denver, CO 80203 -2273 AUTHORIZED REPRESENTATIVE © 1968 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S17613491M1761331 LW01