2012-12-24_GENERAL DOCUMENTS - C1981018

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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 /DYYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Deseret Generation E. Transmission Attn: Robert Dalley 10714 South Jordan Gateway South Jordan, UT 84095 INSURER B : TB1- 641 - 436749 -022 12/30/12 12/30/13 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 2,000,000 INSURER F : CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10, 000 PERSONAL &ADVINJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES JERCT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 0 �V/ �j \ ` �� EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED (Mandatory in NH) If DESCRIPTION OF OPERATIONS below Y / N N / A r � V e {e� \<c-'1 O `t - 5 (\ \ ) \� \'\ \ \ \ ' � WC STATU TORY LIMITS OTH ER E L EACH ACCIDENT $ E L. DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Deserado Mine in Rangely, Colorado (Permit #C -81 -018). State of Colorado Division of Reclamation Mining & Safety 1313 Sherman Street Room Denver, CO 80203 215 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 S7---(2._..-,,..____, °® CERTIFICATE OF LIABILITY I DATE (MMiDD/YYYY) 2 12/19/2012 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 1- 612 - 333 -3323 Hays Companies 80 South 8th Street Suite 700 Minneapolis, MN 55402 CONTACT NAME: PHONE FAX (A/C, No. Ext): 612 (A/C, No): 612 A ADD DREDRE SS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: LIBERTY MUT INS CO 23043 INSURED Deseret Generation E. Transmission Attn: Robert Dalley 10714 South Jordan Gateway South Jordan, UT 84095 INSURER B : INSURERC: INSURERD: INSURER E: INSURER F : COVERAGES CERTIFICATE HOLDER ACORD 25 (2010/05) ericj CERTIFICATE NUMBER: 30754808 REVISION NUMBER: CANCELLATION © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD