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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
<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 AFFORDED 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUER
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />(MMIDD/YYYY)
<br />POLICY EXP
<br />(MM /DD/YYYY)
<br />LIMITS
<br />A
<br />GENERAL
<br />X
<br />LIABILITY
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURED DIVISlOIl
<br />CHEVRON MINING, INC. j\ii ',g, `,
<br />116 INVERNESS DRIVE
<br />SUITE 207
<br />ENGLEWOOD, CO 80112
<br />INSURER C
<br />CMRG25839882
<br />03/01/2013
<br />03/01/2014
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PR S l RENTED
<br />PREMISES (Ea occurrence)
<br />$
<br />X
<br />CLAIMS -MADE
<br />OCCUR
<br />MED EXP (Any one person)
<br />$
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 1,000,000
<br />GEN'L AGGREGATE
<br />POLICY
<br />LIMIT APPLIES
<br />PRO JFCT
<br />PER
<br />LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ 1,000,000
<br />$
<br />AUTOMOBILE
<br />__
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED
<br />AUTOS
<br />HIRED AUTOS
<br />SCHEDULED
<br />AUTOS
<br />NON -OWNED
<br />AUTOS
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />_
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />XLXG25839912
<br />03/01/2013
<br />03/01/2014
<br />EACH OCCURRENCE
<br />$ 3,500,000
<br />AGGREGATE
<br />$ 6,500,000
<br />DED
<br />RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED/
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />Y / N
<br />N / A
<br />WC STATU-
<br />TORY LIMITS
<br />OTH
<br />ER
<br />E L EACH ACCIDENT
<br />$
<br />E L DISEASE - EA EMPLOYEE
<br />$
<br />E L DISEASE - POLICY LIMIT
<br />$
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />This Certificate shall provide for personal injury and property damage as a result of surface coal mining and reclamation operations including arising from the use of explosives at the Insured "s Edna Mine in
<br />Colorado The issuing Company shall notify the below named Certificate Holder whenever substantive changes are made in the above descnbed policies includin• tejmination or failure to renew, within 30 days.
<br />7
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<br />ACRD CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM /DD/YYYY)
<br />01/29/2013
<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 />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS 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 lieu of such endorsement(s). ,.. • °
<br />PRODUCER a, "
<br />MARSH RISK & INSURANCE SERVICES
<br />345 CALIFORNIA STREET, SUITE 1300
<br />CALIFORNIA LICENSE NO 0437153 FEB 4 2013
<br />SAN FRANCISC094104
<br />025158 -001 -- SPEC 007C ( G Sama t 10t'
<br />G , (;a tet y
<br />CONTACT
<br />PHONE FAX
<br />(A/C. No, Ext)' (A/C, No):
<br />E -MAIL
<br />ADDRESS
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />22667
<br />INSURER A : ACE American Insurance Company
<br />INSURER B •
<br />INSURED DIVISlOIl
<br />CHEVRON MINING, INC. j\ii ',g, `,
<br />116 INVERNESS DRIVE
<br />SUITE 207
<br />ENGLEWOOD, CO 80112
<br />INSURER C
<br />INSURER D .
<br />INSURER E :
<br />INSURER F .
<br />COVERAGES
<br />CERTIFICATE HOLDER
<br />ACORD 25 (2010/05)
<br />CERTIFICATE NUMBER:
<br />SEA - 002032363 - 48
<br />REVISION NUMBER: 19
<br />CANCELLATION
<br />Division of Reclamation,
<br />Minerals and Safety
<br />Attn Janet Binns
<br />1313 Sherman Street, Room 215
<br />Denver, CO 80203 -2273
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh USA Inc.
<br />Wendy Sokol U.&,e4 a zoxa(
<br />© 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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