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2014-08-11_GENERAL DOCUMENTS - C1994082
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2014-08-11_GENERAL DOCUMENTS - C1994082
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Last modified
8/24/2016 5:46:37 PM
Creation date
8/11/2014 10:31:59 AM
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Template:
DRMS Permit Index
Permit No
C1994082
IBM Index Class Name
General Documents
Doc Date
8/11/2014
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JHB
Media Type
D
Archive
No
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A °® CERTIFICATE OF LIABILITY INSURANCE <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />page 1 of 1 <br />08/`01/20 4 <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 />q/CNO EXT: 877- 945 -7378 A/C No: 888- 467 -2378 <br />E -MAIL <br />ADDRESS: CertificatesQwillis.com <br />8/1/2014 <br />8/1/2015 <br />EACH OCCURRENCE <br />INSURER(S)AFFORDING COVERAGE <br />NAIC# <br />INSURERA: ACE American Insurance Company <br />22667 -001 <br />X COMMERCIAL GENERAL LIABILITY <br />INSURED <br />Peabody Energy Corporation and Subsidiaries <br />INSURERS: <br />INSURER C: <br />Attn: Robert Fenley <br />701 Market Street <br />CLAIMS -MADE OCCUR <br />Suite 700 <br />INSURER D: <br />INSURER E: <br />St. Louis, MO 63101 -1826 <br />INSURER F: <br />PERSONAL& ADV INJURY <br />$ 5,000,000 <br />COVERAGES CERTIFICATE Nt1MRER! 21898628 RFVISICIN NIIMRFR- <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 />TR <br />TYPEOFINSURANCE <br />ADDT <br />INSR <br />SUB <br />WVD <br />pOLICYNUMBER <br />POLICY EFF <br />YYY <br />POLICY EXP <br />M DD YY Y <br />LIMITS <br />• <br />GENERAL LIABILITY <br />HDOG2733636A <br />8/1/2014 <br />8/1/2015 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />DAMAGETORENTED <br />PREMISES Eaoccurence <br />$ 100,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />VIED EXP (Anyone person) <br />$ 5,000 <br />PERSONAL& ADV INJURY <br />$ 5,000,000 <br />GENERAL AGGREGATE <br />$ 61000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS • COMP/OP AGG <br />$ 6,000,000 <br />$ <br />POLICY 71 PECOT- LOC <br />• <br />AUTOMOBILE LIABILITY <br />ISAH08827540 <br />8/1/2014 <br />8/1/2015 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 5, 000, 000 <br />BODILY INJURY(Per person) <br />$ <br />X ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY(Per accident) <br />$ <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />Per accident) <br />$ <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />HCLAIMS-MADE <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />RECE <br />DED RETENTION $ <br />$ <br />TM& <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y <br />ANY PROPRIETOR/PARTNER /EXECUTIVE � <br />OFFICER/MEMBER EXCLUDED? <br />(/Mandatory . in NH) <br />If yes, e under <br />N/A <br />A <br />i1 <br />O{ 6 clam <br />`Vl$10� CJa{ <br />& <br />t�0n' <br />A U- <br />T CRY LIMI TS ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />I DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) <br />Named Insured: Seneca Coal Co., a Subsidiary <br />Covers operations at Yoast Mine including damage form surface coal mine operations, the use of <br />explosives and damage to water wells. <br />GEH I IFI(;A 1 E HULUEH GANGELLATIUN <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 />AUTHORIZED REPRESENTATIVE <br />Colorado Division of Reclamation, Mining & Safety <br />1313 Sherman Street, Room 215 Jkv') <br />Denver, CO 80203 <br />Coll:4480066 Tz)1:1848077 Cert:2 8628 © 1988- 2010ACORD CORPORATION. All riahts reserved <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />
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