2013-07-26_GENERAL DOCUMENTS - C1992080

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17 I 1'tL L- -- CERTIFICATE QF LIABILITY INSURANCE DATE (MMIDDIYYYY) 7/12/2013 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(les) 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 Allred- Thompson - Mason- Daugherty Ins. A Division of Higginbotham Agency 1300 Tenth Street g y CON ACT NAME Sylvia York PHONE FAX No EM •940 -723- 771 ac No 40 -7 3 -5309 ADDRESS INSUREII AFFORDING COVERAGE NAIC# Wichita Falls TX 76301 INSURER A Texas MutualInsurance Company 22945 EACH OCCURRENCE INSURED OAKRI 1 INSURER B: COP,IMERCIAL GENERAL LIABILITY INSURER C' Oakridge Energy Inc 4613 Jacksboro Hwy Wichita Falls TX 76302 INSURER D DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP fAry ore person) INSURER E INSURER F C(JVERAGE5 CERTIFICATE NUMBER: 17177f)Qd3Q 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 INSR LTR TYPE OF INSURANCE ADDL IN SR UBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP IMMJDD1YYYY1 LIMITS JUL 2 6 2013 GENERAL LIABILITY EACH OCCURRENCE $ COP,IMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP fAry ore person) $ CLAIMS -MACE F—I OCCUR PERSONAL & ADV INJURY $ GENERALAGGREGATF $ GE N'L AGGREGATE LIFAIT APPLIES PER —1 PRODUCTS - COMP/OP AGG $ POLICY PRO LOC JECT $ AUTOMOBILE LIABILITY Ea acciden0 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED r_ SCHEDULED AUTOS �--I AUTOS HARED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ X EXCESS LIAB CLAIMS -MADE AGGREGATE $ $ DED_ R_ET_ENTION $ _ _ _ r Y y A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N 817`0001027321 7JI412013 /14(2014 WC STATU- OTH- TORY LIMITS FR FL EACH ACCIDENT $1,000.000 ANY PROPRIETORMARTNEREXECUTIVE OFFICERIMEMBER EXCLI.DEI ❑ N / A E L DISEASE - EA EMPLOYEE $1 000 000 (Mandatory in NH) If yes, describe under E L DISEASE - POLICE LIMIT $1 ,000 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Carbon Junction Mine,La Plata County Colorado The Workers Compensation policy include an endorsement providing 30 days notice of cancellation (or coverage change) will be furnished to the certificate holder. P• N77 smiw-v v:m:rsimaL:s 11111IF27A \1521 d■Lr Jr... D 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QWffZW &Jo are registered marks of ACORD MINING AND SAFETY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Division of Reclamation, Mini ,�afg� Dearnent ACCORDANCE WITH THE POLICY PROVISIONS. of Natural Resources CE�VED 1313 Sherman St., Room 21 ��RR`` AUTHORIZED REPRESENTATIVE Denver CO 80203 JUL 2 6 2013 D 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QWffZW &Jo are registered marks of ACORD MINING AND SAFETY