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A <br />C O CERTIFICATE OF LIABILITY INSURANCE <br />M/DDlYYYY) <br />DATE (M <br />L/ 0 <br />6/26/ <br />06/26/2009 <br />PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br />Marsh USA Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />1166 Avenue of the Americas HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />New York, NY 10036-2774 <br />Attn: Ne <br />Y <br />k <br />t <br />M <br />h <br />F ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />w <br />or <br />.cer <br />s@ <br />ars <br />.com <br />ax: 212-948-0500 <br />008046-ALL-cas-09-10 <br />M„ , INSURERS AFFORDING COVERAGE NAIC # <br />INSURED ? ??? <br />-? <br />W. R. GRACE & CO. <br /> <br />INSURERA: Hartford Fire Insurance Co <br /> <br />19682 <br />7500 GRACE DRIVE ' +`L <br />MD 21044 JU O 't" 20 9 <br />COLUMBIA INSURER B: N/A N/A <br />, INSURER C: <br />n <br />ti <br />, <br />o <br />oiVision OI meclarna INSURER D: <br />and Safety <br />i <br />Mi <br />ng <br />n INS <br /> URER E: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br />CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INS <br />LTR ADD' <br />INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION <br />LIMITS <br /> DATE(MM/DD/YYYY) DATE(MMIDDIYYYY) <br /> GENERAL LIABILITY SELF INSURED 06/30/2009 06/30/2010 EACH OCCURRENCE 5.000,006 <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 5 <br />000 <br />000 <br /> <br />- PREMISES Ea occurrence , <br />, <br /> E <br />1 <br /> CLAIMS MADE <br />OCCUR MED EXP (Any one person) $ EXCLUDED <br /> X S F-INSLIR D PERSONAL &ADV INJURY <br />$ 5 <br />000 <br />000 <br /> , <br />, <br /> W. R. GRACE & CO GENERAL AGGREGATE $ <br /> GE NERAL AGGREGATE LIMIT APPLIES PE <br /> R <br />PRO PRODUCTS - COMP/OP AG <br /> POLICY <br />LOC <br />JECT <br />A AUTOMOBILE LIABILITY 10 CSE C47908 06/30/2009 06/30/2010 <br /> COMBINED SINGLE LIMIT <br />000 <br />000 <br />$ 2 <br /> X ANY AUTO (Ea accident) , <br />, <br /> <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS <br />(Per person) <br /> HIRED AUTOS <br /> BODILY INJURY $ <br /> NON-OWNED AUTOS (Per accident) <br /> R PROPERTY DAMAGE <br /> (Per accident) $ <br /> <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHERTHAN EA ACC $ <br /> AUTO ONLY: $ <br /> AGG <br /> EXCESS / UMBRELLA LIABILITY <br />- EACH OCCURRENCE $ <br /> OCCUR F <br />1 CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> <br /> RETENTION $ <br /> WORKERS COMPENSATION AND X WC STATU- OTH- <br /> EMPLOYERS' LIABILITY SEE ADDITIONAL PAGE <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />OFFICER/MEMB <br />- .L. EACH ACCIDENT $ 2,000,000 <br /> ER EXCLUDED? <br />N <br /> F L. DISEASE - EA EMPLOYE $ 2,000,000 <br /> (Mandatory in NH) If yes, describe under <br />SPECIAL PROVISIONS below <br />L. DISEASE -POLICY LIMIT <br />$ 2,000,000 <br /> OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />The coverage and limits stated above apply to Permit #C80-003 <br />CERTIFICATE HOLDER NYC-003677596-14 CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />Colorado Division of Minerals and EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />Geology <br />Attn: Jim Stark 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />1313 Sherman Street - Room 215 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND <br />Denver, CO 80203 P <br />O <br />N <br />THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />UU <br /> H <br />R <br />II?? <br />ppRREE <br />of Ma?ShEUSAPIncSENTATNE <br /> David Kong <br />@ 1998-2009 ACORD CORPORATION. All Rights Reserved <br />The ACORD name and logo are registered marks of ACORD