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2013-11-05_GENERAL DOCUMENTS - C1982057
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2013-11-05_GENERAL DOCUMENTS - C1982057
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Last modified
8/24/2016 5:36:52 PM
Creation date
11/5/2013 1:00:17 PM
Metadata
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Template:
DRMS Permit Index
Permit No
C1982057
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
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A� °® CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 <br />1DATE <br />0/(30/2013 <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 />NAME <br />Willis of Tennessee, Inc. <br />c/o 26 Century Blvd. <br />P.O. Box 305191 <br />Nashville, TN 37230 -5191 <br />PHONE FAX <br />AC NO EXT 877 - 945 -7378 (A/C. No 888- 467 -2378 <br />E -MAIL <br />ADDRESS certificates@willis.com <br />INSURER(S)AFFORDING COVERAGE <br />NAIC# <br />INSURERA ACE American Insurance Company <br />22667 -001 <br />DAMAGE TO RENTED <br />PREMISES Eaoccurence <br />INSURED <br />Peabody Energy Corporation and Subsidiaries <br />INSURERB <br />$ 5,000 <br />INSURER <br />$ 5,000,000 <br />Attn: Robert Fenley <br />701 Market Street <br />Suite 700 <br />INSURER <br />$ 6 000 000 <br />INSURER <br />PRODUCTS - COMP/OP AGG <br />St. Louis, MO 63101 -1826 <br />INSURER F <br />• <br />COVERAGES CERTIFICATE NUMBER: 20640042 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 />INSR <br />LTR <br />TYPEOFINSURANCE <br />DD' <br />N <br />SUB <br />WV <br />pOLICYNUMBER <br />POLICY EFF <br />M DD YY <br />LICYP <br />M <br />LIMITS <br />• <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE1 OCCUR <br />Denver, CO 80203 -2273 <br />HDOG2732809A <br />11/1/2013 <br />11/1/2014 <br />EACHOCCURRENCE <br />$ 5,000,000 <br />DAMAGE TO RENTED <br />PREMISES Eaoccurence <br />$ 100 000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL& ADV INJURY <br />$ 5,000,000 <br />GENERAL AGGREGATE <br />$ 6 000 000 <br />GEN'LAGGREGATE LIMIT APPLIES PER <br />POLICY I PRO- <br />POLICY LOC <br />PRODUCTS - COMP/OP AGG <br />$ 6,000,000 <br />• <br />' AUTOMOBILE LIABILITY <br />X ANY AUTO <br />ALLOWNED 1 iSCHEDULED <br />AUTOS I AUTOS <br />HIRED AUTOS NON -OWNED <br />iAUTOS <br />ISAH08815306 <br />��� <br />(� 0 <br />V� <br />2013 <br />)0 �� <br />ll <br />h <br />11/1/2014 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 5,000,000 <br />BODILYINJURY(Perperson) <br />$ <br />BODILY INJURY(Peracadent) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />O M\N�1` <br />EG <br />EACHOCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED ( RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY Y/N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE F--j <br />OFFICER/MEMBER EXCLUDED' I <br />((Mandatory in NH) <br />rf yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />I N rA <br />TORY LIMIT ER <br />E L EACH ACCIDENT <br />$ <br />EL DISEASE - EA EMPLOYEE <br />$ <br />EL DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach Acord 101, Additonal Remarks Schedule, if more space is required) <br />Named Insured: Seneca Coal Co., a Subsidiary <br />Covers operations at Seneca II -W Mine including damage from surface coal mine operations, the use <br />of explosives and damage to water wells. <br />CERTIFICATE HOLDER CANCELLATION <br />Coll:4253132 Tpl:1725220 Cert:26_M0042 © 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 />Denver, CO 80203 -2273 <br />Coll:4253132 Tpl:1725220 Cert:26_M0042 © 1988- 2010ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />
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