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2014-08-11_GENERAL DOCUMENTS - C1992081 (2)
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2014-08-11_GENERAL DOCUMENTS - C1992081 (2)
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Last modified
8/24/2016 5:46:37 PM
Creation date
8/11/2014 1:37:45 PM
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Template:
DRMS Permit Index
Permit No
C1992081
IBM Index Class Name
General Documents
Doc Date
8/11/2014
Doc Name
Certificate of Liablity 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 <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/`0 /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 30 <br />Nashville, TN 37230 -5191 <br />NAME: <br />PHONE FAX <br />AC No EXT: 877- 945 -7378 A/C NO): 888 - 467 -2378 <br />ADDRESS: certificates@willis.com <br />ESS: cerificates@Willis.com <br />8/1/2014 <br />8/1/2015 <br />EACHOCCURRENCE <br />INSURER(S)AFFORDING COVERAGE <br />NAIC # <br />INSURERA:ACE American Insurance Company <br />22667 -001 <br />INSURED <br />Peabody Energy Corporation and Subsidiaries <br />INSURERB: <br />INSURERC: <br />$ 100 000 <br />Attn: Robert Fenley <br />701 Market Street <br />CLAIMS -MADE OCCUR <br />Suite 700 <br />INSURERD: <br />INSURER E: <br />St. Louis, MO 63101 -1826 <br />INSURER F: <br />PERSONAL SADVINJURY <br />$ 5,000,000 <br />COVERAGES CERTIFICATE NUMBER: 21898626 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 />TYPE OF INSURANCE <br />DD' <br />SUB <br />POLICY NUMBER <br />POLICY EFF <br />D YY <br />POLICY EXP <br />M Y <br />LIMITS <br />A <br />GENERAL LIABILITY <br />HDOG2733636A <br />8/1/2014 <br />8/1/2015 <br />EACHOCCURRENCE <br />$ 51000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />PREMISES Eaoccurence <br />$ 100 000 <br />CLAIMS -MADE OCCUR <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL SADVINJURY <br />$ 5,000,000 <br />GENERAL AGGREGATE <br />$ 6,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />$ 6,000,000 <br />-7 <br />PRO- LOC <br />POLICY <br />$ <br />A <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 ANYAUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON - OWNED <br />AUTOS <br />. _ <br />R f!c r <br />�4aa <br />BODILYINJURY(Peraccident) <br />$ <br />PR PERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />Ld <br />OCCUR <br />AU6 120 1 A <br />U `I <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />D <br />DED RETENTION $ <br />$ <br />vision of Rec <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N <br />1111ning & Safety-" <br />TORY LIMIT ER <br />ANY PROPRIETOR/PARTNER /EXECUTIVE ❑ <br />OFFICER/MEMBER EXCLUDED? <br />N/A <br />E.L. EACH ACCIDENT <br />$ <br />(Mandatory in NH) <br />f yes, describe under <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach Acord 101, Additional 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 />L,r-K I It 11.;A I t rtULUtli L;AN(;tLLA I IUN <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 />Division of Reclamation, Mining and Safety AUTHORIZED REPRESENTATIVE <br />Room 215 / /a <br />1313 Sherman Street <br />Denver, CO 80203 -2273 ' <br />Coll:4480066 Tnl:1848077 Cert:2 8626 01988- 2010ACORnCORPORATION_ All rinhtsresPrvPrl <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />
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