2013-06-07_GENERAL DOCUMENTS - C1983059

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CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) I 05/31/2013 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 CONTACT NAME: PHONE (866) 283 -7122 FAX (800) 363 -0105 (AIC. No. Ect): . No.). E -MAIL ADDRESS: Suite 510 West Palm Beach FL 33401 USA INSURER(S) AFFORDING COVERAGE NAIC # GLO INSURED INSURER A: Zurich American Ins Co 16535 Terror Creek LLC 1601 Forum Place INSURER B: American Guarantee & Liability Ins Co 26247 INSURER C• Suite 1400 West Palm Beach FL 33401 -8101 USA INSURER PREMISES Ea occurrence INSURER E, CLAIMS -MADE X❑ OCCUR INSURER F COVERAGES CERTIFICATE NUMBER: 570050124250 REVISION NUMBER: 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 LTR TYPE OF INSURANCE INSR VWD POLICY NUMBER MMIDDIYYYY MM /DDIYYYY LIMITS Division Of Reclamation, Mining and Safety GENERAL LIABILITY AUTHORIZED REPRESENTATIVE GLO EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY - General Liablity SIR applies per policy terns & COndl ions PREMISES Ea occurrence $1,000,000 CLAIMS -MADE X❑ OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $2,000,000 POLICY PRO X LOC JECT A AUTOMOBILE LIABILITY BAP 9265950-03 Business Automobile Cover 06/01 06/01/2014 COMBINED SINGLE LIMIT Ea accident) $1,000,000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident B X UMBRELLA LIAB X AUC926 593703 06/01/2013 06/01/2014 EACH OCCURRENCE $25,000,000 EXCESS LIAB MADE umbrella SIR applies per policy terns & conditions AGGREGATE $25,000,000 DEC) I X RETENTION $10, 000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC STATU- OTH- TORY LIMITS ER EL EACH ACCIDENT ANY PROPRIETOR I PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA E L DISEASE -EA EMPLOYEE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I 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 LIMB policy. CERTIFICATE HOLDER CANCELLATION L� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Division Of Reclamation, Mining and Safety AUTHORIZED REPRESENTATIVE 1313 Sherman Street, Room 215 Denver Co 80203 USA RECEIVED - tj4l ACORD 25 4� 1 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD logo ACORD (201 name and are registered marks of MIN N® AND SAFETY