2012-10-10_GENERAL DOCUMENTS - C1981010

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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 /DDNYTY) POLICY EXP (MM /DD /YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY IN T RAPPER MINING, INC OCT 10 2012 PO BOX 187 CRAIG, CO 81626 ,vision of Reclamation, Mining & Safety INSURER B : N/A 35907412 10/01/2012 10/01/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 1,000,000 $ MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GE X 'L AGGREGATE POLICY LIMIT APPLIES PRO IECT PER LOC DEDUCTIBLE $ 5,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP14S9310512 10/01/2012 10/01/2013 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EX EXCLUDED? ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N I N / A WC STATU- TORY LIMITS OTH- ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE PERMIT #C-81-010 POLICY INCLUDES COVERAGE FOR PROPERTY DAMAGE AND PERSONAL INJURY RESULTING FROM THE USE OF EXPLOSIVES COLORADO DIVISION OF RECLAMATION AND SAFETY DEPARTMENT OF NATURAL RESOURCES 1313 SHERMAN STREET - ROOM 215 DENVER, CO 80203 I 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 of Marsh USA Inc. Sharon A Hammer C✓''- . —__- Q - c - A./ ms ACORD ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM 2 /YYYY) 10/E /201 2 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 MARSH USA INC 1225 17TH STREET, SUITE 2100 DENVER, CO 80202 -5534 �/ Attn Denver CertRequest@marsh com / FAX 212 -94 j E� Y E� S67982- 00125 - ALL -12 -13 CONTACT PH PHONE FAX (A/C No. Extl: (A/C, No): E - MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 20281 INSURER A : Federal Insurance Company IN T RAPPER MINING, INC OCT 10 2012 PO BOX 187 CRAIG, CO 81626 ,vision of Reclamation, Mining & Safety INSURER B : N/A N/A INSURER C : St. Paul Fire & Marine Ins Co 24767 INSURER D : N/A N/A INSURER E : INSURER F COVERAGES ACORD 25 (2010/05) CERTIFICATE NUMBER: SEA - 002108815 - 28 REVISION NUMBER:7 CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD