My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2013-11-05_GENERAL DOCUMENTS - C1992081
DRMS
>
Day Forward
>
General Documents
>
Coal
>
C1992081
>
2013-11-05_GENERAL DOCUMENTS - C1992081
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/24/2016 5:36:53 PM
Creation date
11/5/2013 1:00:13 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1992081
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
11/5/2013
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JHB
DIH
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
Page 1 of 1
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
ACC>R °® CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 <br />FD�ATE 0 3 /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 <br />CONTACT <br />Willis of Tennessee, Inc. <br />c/o 26 Century Blvd. <br />P.O. Box 305191 <br />Nashville, TN 37230 -5191 <br />NAME <br />PHONE FAX <br />A/C NO EXT 877 - 945 -7378 A/C NO 888- 467 -2378 <br />E -MAIL <br />ADDRESS' certificates@Willis.Com <br />1 EACH OCCURRENCE <br />$ 5,000,000 <br />PREMI ETORENTED <br />PREMISES Eaoccurence <br />INSURER(S)AFFORDING COVERAGE <br />NAIC# <br />INSURERA ACE American Insurance Company <br />22667 -001 <br />$ 5,000,000 <br />INSURED <br />Peabody Energy Corporation and Subsidiaries <br />INSURER <br />$ 6,000,000 <br />INSURERC <br />PRODUCTS - COMP/OP AGG <br />Attn: Robert Fenley <br />701 Market Street <br />$ <br />A <br />Suite 700 <br />INSURER D. <br />INSURER <br />11/1/2013 <br />St. Louis, MO 63101 -1826 <br />INSURER F <br />$ 5,000,000 <br />BODILY INJURY(Per person) <br />COVERAGES CERTIFICATE NUMBER: 20640043 REVISION NUMBER: <br />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 />IN RI <br />LTR TYPEOFINSURANCE <br />DD' <br />FI <br />SUB <br />yyyp <br />POLICY NUMBER <br />POLICY EFF <br />M D YY <br />POLICY EXP <br />M/DD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />Room 215 <br />HDOG2732809A <br />11/1/2013 <br />11/1/2014 <br />1 EACH OCCURRENCE <br />$ 5,000,000 <br />PREMI ETORENTED <br />PREMISES Eaoccurence <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />$ 5,000,000 <br />� <br />GENERALAGGREGATE <br />$ 6,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />POLICY PE I 7 LOC <br />PRODUCTS - COMP/OP AGG <br />$ 6,000,000 <br />$ <br />A <br />'I AUTOMOBILE LIABILITY <br />X ANY AUTO <br />ALLOWNED 'SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS IA <br />AUTOS <br />ISAH08815306 <br />11/1/2013 <br />11/l/2014 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 5,000,000 <br />BODILY INJURY(Per person) <br />$ <br />BODILY INJURY(Per accident) <br />$ <br />DAMAGE <br />PROPERTY Per accident <br />$ <br />$ <br />UMBRELLA LAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />fy <br />` <br />" �� <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED 'RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY Y/N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICEWMEMBER EXCLUDED <br />((Mandatory m NH) <br />ff yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N/A <br />�Q <br />,t�� \� <br />4GV <br />h Cj <br />W TA U- TH- <br />TORY LIMIT 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/ VEHICLES (Attach Acord 101, Addrtonal Remarks Schedule, if more space is required) <br />Named Insured: Hayden Gulch Terminal, Inc. <br />Covers operations at Hayden Gulch Loadoul Facility including damage from surface coal, etc., <br />Permit <br />C -92 -081. <br />CERTIFICATE HOLDER CANCELLATION <br />Coll:4253132 Tpl:1725220 Cert:206-00043 © 1988- 2010ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <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 />Colorado Department of Natural Resources <br />AUTHORIZED REPRESENTATIVE <br />Division of Reclamation, Mining and Safety <br />Room 215 <br />1313 Sherman Street <br />/ <br />Denver, CO 80203 -2273 <br />I /� <br />��^✓ <br />Coll:4253132 Tpl:1725220 Cert:206-00043 © 1988- 2010ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />
The URL can be used to link to this page
Your browser does not support the video tag.