2012-12-12_REVISION - C1983059 - Laserfiche WebLink

Home Browse Search

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 Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF IMM/DDIVYYY) POLICY EXP IMM/DDM'YY) LIMITS B GENERAL LIABILITY INSURER A. Zurich American Ins Co 16535 GLO926594902 General Li abl i ty SIR applies per policy terms 6/01/1012 & conditions 06/01/1013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [] OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER 7 POLICY n .19 ^ I LOC PRODUCTS - COMP /OP AGG $2,000,000 A AUTOMOBILE LIABILITY BAP 9265950 -02 Business Automobile cover 06/01/2012 06/01/2013 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) C X UMBRELLA MB EXCESS LIAR X OCCUR CLAIMS - MADE UMB926593702 Umbrella SIR applies per policy terns 06/01/2012 & condi-ions 06/01/2013 EACH OCCURRENCE $25,000,000 AGGREGATE $25,000,000 DED I X'RETENTION $10 000 WORKERS COMPENSAT ON AND EMPLOYERS' LIABILITY N I A I WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED' (Mandatory In NH) Y / N E L EACH ACCIDENT E L DISEASE -EA EMPLOYEE If yes, descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Permit number C - 1983 -059 ' Terror Creek Loadout " Division of Reclamation, mining and safety is included as Additional Insured as required by written contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the Auto, GL and uMB policy. AC D a 14.---- CERTIFICATE OF LIABILITY INSURANCE DAT ( M /DD 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 Aon Risk Services, Inc of Florida 222 Lakeview Avenue Suite 510 West Palm Beach FL 33401 USA CONTACT NAME: PHONE (A/C. No. Ext): (866) 283 -7122 FAX No): (847) 953 -5390 E ADDRESS INSURER(S) AFFORDING COVERAGE NAIC # INSURED Terror creek LLC 1601 Forum Place Suite 1400 West Palm Beach FL 33401 -8101 USA INSURER A. Zurich American Ins Co 16535 INSURERB American Zurich Ins Co 40142 INSURER C. American Guarantee & Liability Ins Co 26247 INSURER 0 INSURER E: INSURER F COVERAGES CERTIFICATE HOLDER ACORD 25 (2010/05) CERTIFICATE NUMBER: 570046528807 CANCELLATION REVISION NUMBER: Division of Reclamation, Mining and Safety 1313 Sherman Street, Room 215 Denver CO 80203 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 e�aasa o7Z.�fc c/sbetiivl0 ✓sra a ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD