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2015-07-28_GENERAL DOCUMENTS - C1982057
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2015-07-28_GENERAL DOCUMENTS - C1982057
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Last modified
8/24/2016 6:09:26 PM
Creation date
7/28/2015 12:15:50 PM
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DRMS Permit Index
Permit No
C1982057
IBM Index Class Name
General Documents
Doc Date
7/28/2015
Doc Name
Certificate of Liability Insurance
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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PEABENE-01 LEWISJY <br />ACORL7 <br />CERTIFICATE OF LIABILITY INSURANCE <br />ATE (MM/DD/YYYY) <br />P7/22/2015 <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 Willis Certificate <br />NAME: Center <br />Willis of Tennessee, Inc. <br />c/o 26 Century Blvd(AIC.No <br />P.O. Box 305191 <br />PHONE (g77) 945-7378 (FAX, No ; (888) 467-2378 <br />Ext: <br />ADDE-MRESS: certificates@willis.com <br />Nashville, TN 37230-5191 <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURERA:ACE American Insurance Company 22667 <br />INSURED <br />Peabody Energy Corporation and Subsidiaries <br />Attn: Robert Fenley <br />INSURER B: <br />INSURER C : <br />CLAIMS -MADE [XI OCCUR <br />701 Market Street <br />INSURER D: <br />INSURER E: <br />Suite 700 <br />St. Louis, MO 63101-1826 <br />INSURER F <br />CnVFRAGFS CERTIFICATE NUMBER: 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 />ILTR <br />TYPE OF INSURANCE <br />ADDLISUBR <br />INSD <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM DD/YYYY <br />POLICY EXP <br />MM DD//YYYY <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />Denver CO 80203-2273 <br />EACH OCCURRENCE $ 5,000,000 <br />CLAIMS -MADE [XI OCCUR <br />HDOG27396367 <br />08/01/2015 <br />08/01/2016 <br />DAMAGE TO <br />PREMISES Eaoccu RENTED <br />$ 100,00 <br />MED EXP (Any one person) $ 5,00 <br />PERSONAL & ADV INJURY $ 5,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE $ 6,000,000 <br />POLICY � PRO JECT ❑ LOC <br />PRODUCTS - COMP/OP AGG $ 6,000,000 <br />$ <br />OTHER <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ 5,000,000 <br />Ea accident <br />BODILY INJURY (Per person) $ <br />A <br />X ANY AUTO <br />ISAH08858299 <br />08/01/2015 <br />08/01/2016 <br />BODILY INJURY (Per accident) $ <br />ALL OWNEDSCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE $ <br />Per acadent <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATIONPER <br />AND EMPLOYERS' LIABILITY YIN_ <br />ANY PROPRIETOR/PARTNERIEX <br />OFFICER/MEMBER EXCLUDED ECUTIVE EJ <br />(Mandatory in NH) <br />N / A <br />1 i�. <br />OTH- <br />STATUTE ER <br />E L EACH ACCIDENT $ <br />E L DISEASE - EA EMPLOYEE $ <br />E L DISEASE - POLICY LIMIT $ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />r <br />JUL.) <br />CLA.MATION <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule may attached 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 of explosives and damage to water wells. <br />CFRTIFICATF Hnl nFR CANCELLATION <br />ACORD 25 (2014/01) <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />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 215i/t.( <br />1313 Sherman Street <br />J' <br />f ~ <br />Denver CO 80203-2273 <br />ACORD 25 (2014/01) <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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