2012-12-10_GENERAL DOCUMENTS - C1992080

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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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DDIYYYY) POLICY EXP (MM/DD /YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL NSURED OAKRI1 O '10 ' a Oakridge Energy Inc ‘)k-G 4613 Jacksboro Hwy mad Wichita Falls TX 76302 Re p�v ia)°'� ° { g, S u e ty MO LIABILITY OCCUR SURERD 04GL000864066 12/5/2012 12/5/2013 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 CLAIMS -MADE X MED EXP (Any one person) $Excluded PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. P OLICY Ti F T n LOC PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS -OWNED 04CA002792947 1215/2012 12/5/2013 COMBINED SINGLE LIMI (E a accident) $ X BODILY INJURY (Per person) $1,000,000 SCHEDULED AUTOS BODILY INJURV ( Per accident ) $1,000,000 — I NON AUTOS PROPERTY DAMAGE (Per accident) $ A UMBRELLALIAB EXCESS LIAR OCCUR CLAIMS -MADE 04XS178960 12/5/2012 12/5120 EACH OCCURRENCE $1,000,000 X AGGREGATE $1,000,000 DED X RETENTION $10,000 $ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED'> ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS bebw N/A SBP0001027321 7/14/2012 7/14/2013 WC STATU- OTH- TORY LIMITS ER EL EACH ACCIDENT $1,000,000 E L DISEASE - EA EMPLOYEE $1 ,000,000 E L DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Carbon Junction Coal Mine, CDRMS Permit #C- 92 -080, Ewing Mesa, La Plata County, Colorado Certificate Holder will be given 30 day Notice of Cancellation. 30 DNOC — 10 Non -Pay. , o l e o® CERTIFICATE OF LIABILITY INSURANCE 1 1 2�5� 2 o ` 12 D°`' 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(les) 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 Allred- Thompson- Mason - Daugherty Ins. A Division of Higginbotham Agency 1300 Tenth Street " F Wichita Falls TX 76301 RE��ev G NAME: S y l v i a Y o r k PHONE No. Extl•940- 723 -0771 FAX No)940- 723 -5309 E-MAIL A DDRESS•syork(�higginhotham.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER Mid-Continent Insurance Company INSURER B Texas Mutual Insurance Company 22945 NSURED OAKRI1 O '10 ' a Oakridge Energy Inc ‘)k-G 4613 Jacksboro Hwy mad Wichita Falls TX 76302 Re p�v ia)°'� ° { g, S u e ty MO MSURER C : SURERD INSURER E : INSURER F : COVERAGES CERTIFICATE HOLDER ACORD 25 (2010105) CERTIFICATE NUMBER: 5724350 CANCELLATION REVISION NUMBER: Colorado Division of Reclamation, Mining & Safety 1313 Sherman, Room #215 Denver 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 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD