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2015-01-27_REVISION - C2009087
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2015-01-27_REVISION - C2009087
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Entry Properties
Last modified
8/24/2016 5:56:56 PM
Creation date
1/27/2015 10:03:40 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C2009087
IBM Index Class Name
Revision
Doc Date
1/27/2015
Doc Name
Letter & Application
From
Pebody Sage Creek Mining, LLC
To
DRMS
Type & Sequence
RN1
Email Name
JDM
DIH
Media Type
D
Archive
No
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A� ° CERTIFICATE OF LIABILITY INSURANCE <br />DATE <br />Page 1 of 1 <br />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 />theterms 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 />KIAMP <br />Willis of Tennessee, Inc. <br />c/o 26 Century Blvd. <br />PHONE . 877- 945 -7378 FAx 888 - 467 -2378 <br />-MAIL certificates@willis.com <br />P. o. sox 305191 <br />Nashville, TN 37230 -5191 <br />INSURER(S)AFFORDING COVERAGE <br />NAIC# <br />EACH OCCURRENCE <br />INSURERA:ACE American Insurance Company <br />22667 -001 <br />$ 100 000 <br />INSURED <br />Peabody Energy Corporation <br />INSURERS: <br />INSURER C: <br />Attn: Robert Penley <br />701 Market Street <br />INSURERO: <br />MEDEXP Anyone person) <br />Suite 700 <br />INSURER E: <br />$ 51000,000 <br />St. Louis, MO 63101 -1826 <br />INSURER F: <br />COVERAGES CFRTIFICOTF NIIMRFR• 11 namaga 0c111mnei wuraanon. <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 />TYPEOFINSURANCE <br />DD' <br />SUB <br />pOLICYNUMBER <br />POLICY EFF <br />POLICYEXP <br />LIMITS <br />A <br />GENERAL LIABILITY <br />Y <br />HDOG2733636A <br />8/1/2014 <br />8/1/2015 <br />EACH OCCURRENCE <br />$ 51000,000 <br />DAMAq T R�ENTED <br />PREMI S Eaoccurence <br />$ 100 000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADEa OCCUR <br />MEDEXP Anyone person) <br />$ 5 000 <br />PERSONAL BADVINJURY <br />$ 51000,000 <br />GENERAL AGGREGATE <br />$ 6,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ' PRO- LOC <br />PRODUCTS - COMPIOPAGG <br />$ 6,000,000 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />(CEOaMB DS INGLELIMIT <br />$ <br />BODILY INJURY(Per person) <br />$ <br />ANYAUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY(Per accident) <br />$ <br />HIREDAUTOS NON -OWNED <br />AUTOS <br />(R c <br />t4 AMA <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I IRETENTiON $ <br />$ <br />WORKERS COMPENSATION <br />A - <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑ <br />OFFICERIMEMBEREXCLUDED? <br />N /A <br />EL. EACH ACCIDENT <br />$ <br />E.L. DISEASE -EA EMPLOYEE <br />$ <br />andatoryinNH) <br />ye describe under <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESs, <br />CRIPTION OF OPERATIONS below below <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) <br />Re: Peabody Sage Creek Mining, LLC <br />It is agreed that Colorado Division of Reclamation, Mining and Safety is included as an Additional <br />Insured as respects to General Liability where required by contract or agreement. <br />Covers operations at Peabody Sage Creek Mining, LLC including the use of explosives. <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 and Safe <br />1313 Sherman Street, Room 215 <br />Denver, CO 80203 <br />Coll:4480066 Tpl:1848072 Cert:2 8 8658 © 1988- 2010ACORDCORPORATION. All rights reserved <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />
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