2015-08-03_GENERAL DOCUMENTS - C1982056

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PEABENE-01 LEWISJY ACORL7 `14111� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) F7/22/2015 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy certificate holder in lieu of such endors �C td ay require an endorsement. A statement on this certificate does not confer rights to the PRODUCER CONTACT NAME: Willis Certificate Center Willis of Tennessee, Inc. 26 Century Blvd (�Urj .� L� 1 PHONE FAX ac No Ext : (877) 945-7378 p/C No): (888) 467-2378 ADDRESS: certificates@willis.com c/o P.O. Box 305191 Nashville, TN 37230-5191 Dlvlslon of Reclamation, INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:ACE American Insurance Company 22667 Mininci & Safety INSURED INSURER B: Peabody Energy Corporation and Subsidiaries Attn: Robert Fenley INSURER C : INSURER D: 701 Market Street Suite 700 INSURER E: St. Louis, MO 63101-1826 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYW LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE TOCCUR X HDOG27396367 08/01/2015 08/01/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 100 000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 6,000,000 PPOLICY 1-1JECTPRO ❑ LOC PRODUCTS - COMP/OP AGG $ 6,000,000 $ OTHER AUTOMOBILE LIABILITY COEa aMBINEccidentD SINGLE LIMIT $ 5,000, 000 BODILY INJURY (Per person) $ A X ANY AUTO ISAH08858299 08/01/2015 08/01/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE PER OTH- STATUTE I JER L EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED9 ❑ N/A (Mandatory in NH) EL DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Foidel Creek Mine, C1982-056 The insurer will notify the Division of substantial changes in policy, including or failure to renew. Covers operations including damage from surface coal mine operations, the use of explosives and damage to water wells. It is agreed that Colorado Division of Reclamation, Mining and Safety is included as an Additional Insured as respects to General Liability, but solely in regards to work being performed by or on behalf of the Named Insured. CFRTIFICATF HOLDER CANCELLATION ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Colorado Division of Reclamation, Mining and Safety 313 Sherman Street, Room 215j ` _ y Denver CO 80203 ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD