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,�cuWv CERTIFICATE OF LIABILITY INSURANCE OP ID SH I ""' ° ".... "" <br />05/23/12 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />'LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED <br />PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />rMPORTANT., It the certificate holder Is an ADDITIONAL INSURED, tile pa cy es must be endorsed. SUBROGATION S WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In Ileu of such endorsement(s). <br />PRODUCER UVNIAVI <br />NAME: <br />-i5F(ISw FAX <br />Central Insurance Services ``Arc Nn, W)' ...... (A1C.No): <br />E•MdIL <br />4630 Taylorsville Rd ADDRESS: <br />Louisville KY 40220 PRODUCER <br />CUSTOMERID#: BOWIE ^1 <br />Phone:502-- 493 --2370 Fax:502 -493 -2320 INSURER(S) AFFORDING COVERAGE NAIC# <br />. _ . - - <br />INSURED INSURERA: National Union Fire 19445 <br />Bowie Resources LLC _.. <br />Jim Wolff � INSURER Lexington Snsurancw Comp ny <br />6109 Dutchman's Lane Ste 902 INSURERC: <br />Louisville KY 40205 _ ___.._ .. <br />INSURERD: <br />INSURERE: -_ -_ -- <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORULD BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />iNSR ..__.. _ _- _........ ADDL SUB: - - -- - ,- POLICY EFF -- POLICY VXP .. .... <br />LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) i (MMIDDIYYYY) LIMITS <br />GENERAL LIABILITY <br />EACHOCCURRENCE ; s 2000000 <br />A <br />.._,.i COMMERCIAL GENERAL LIABILITY <br />i TDAMAGE-TO- RENTED........ E ...._ ....... <br />GL 6576426 ;02/01/].2 ;02/01/13 PREMISES (Eaoccurrence) i$3,000000 <br />CLAIMS-MADE X OCCUR <br />MEDEXP (Any nnnperson) $ lOOOO <br />PERSONAL&ADVINJDRY 52000000 <br />f... <br />....................... <br />GENERAL AGGREGATE s3000000 <br />- <br />... ..__. <br />AGGREGATE LIM1FITAPPLIESPER: <br />; ; PRODUCTS •COMPIOPAGG i $2000000 <br />POLICY PERO <br />C Ci I LOC <br />jEmp Sen . S IOOOOOO <br />AUTOM0131LE LIABILITY <br />_ , COMBINED SINGLE LIMIT -. S <br />(Ea accident) <br />ANY AUTO <br />BODILY INJURY (Per person) S <br />ALL OWNED AUTOS <br />- .. -. -1 <br />i - - -- -- <br />BODILY INJURY (Per accident) S <br />_ �SCHEDULED AUTOS <br />I i PROi'ERTY DAMAGE <br />HIRED AUTOS <br />I (Per accident) S <br />NOWOWNED AUTOS <br />-- ._ . . __ ..._ .. . ... ... ._ <br />S <br />i <br />5 <br />A <br />X I UMBRELLALIAB (' OCCUR <br />33E12816081 ;02/01/12 ;02/01/13 i EACH OCCURRENCE S10000000 <br />EXCESS LIAB CLAIMS�MADE <br />- <br />f AGGREGATE $ 10000000 <br />DEDUCTIBLE <br />5 <br />X RETENTION $ 10000 <br />S <br />WORKERS COMPENSATION <br />i WC STATU. <br />TORY LIMITS <br />f <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVF�T <br />3 <br />_ER <br />E.L. EACH ACCIDENT 5 <br />OFFICERiMEMBER EXCLUDED? { <br />NIA A <br />- <br />iMandatory In NH) _( <br />j <br />E.L. DISEASE - EA EMPLOYEE S <br />II os, describe under <br />DESCRIPTION OF OPERATIONS belDw <br />— -- - <br />E,L. DISEASE • POLICY LIMIT S <br />B <br />Excess Umbrella <br />I <br />025267252 ;02/01/12 <br />02/01/13 <br />Excess 15000000 <br />Umbrellla <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Addlllonal gmarlrs Schedule, If m fo spa o Is ro ?trod) <br />Eviden a of Insurance as respects to Bowie 2 Mine Permit I�C --0�6 -083 and <br />Bowie 1 Mine Permit #C86 -038. General T.iab ity policy provides protection <br />for use of explosives. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />STATECO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />State of Colorado ACCORDANCE WITH THE POLICY PROVISIONS. <br />Department of Natural Resource <br />Div. of Minerals & Geology AUTHORIZEqq��ttEPRESENTATIVE <br />1313 Sherman St, Room 215 �a �J "'t <br />Denver CO 80230 Rober s 1, f 0 , <br />ACORD 25 (2009109) <br />©1980 -2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />