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2015-08-31_GENERAL DOCUMENTS - C1981041
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2015-08-31_GENERAL DOCUMENTS - C1981041
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Last modified
8/24/2016 6:10:16 PM
Creation date
9/2/2015 10:27:51 AM
Metadata
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DRMS Permit Index
Permit No
C1981041
IBM Index Class Name
General Documents
Doc Date
8/31/2015
Doc Name
Certificate of Insurance
From
Tonya Hammond
To
DRMS
Permit Index Doc Type
Insurance
Email Name
BFB
DIH
Media Type
D
Archive
No
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v CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />06/29/2015 <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(les) 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 />MCGRIFF, SEIBELS & WILLIAMS, INC. <br />P.O. Box 10265 <br />CONTACT <br />NAME: <br />PHONE <br />A/CC No Ext :800 476-2211 aC, No): <br />Birmingham, AL 35202 <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />3710-63-20 <br />INSURERA:Federal Insurance Company <br />20281 <br />EACH OCCURRENCE <br />INSURED <br />American Electric Power Company, Inc. and all Subsidiaries <br />INSURER B: <br />X CLAIMS -MADE OCCUR <br />INSURER C : <br />1 Riverside Plaza <br />Columbus, OH 43215 <br />INSURER D <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />INSURER E : <br />MED EXP (Any one person) <br />$ <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER:KGDHUVQC 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 />ADDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />United States <br />kA. <br />3710-63-20 <br />07/01/2015 <br />07/01/2018 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />X CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$ 1,000,000 <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />X POLICY â JECT PRO Fâ]LOC <br />PRODUCTS - COMP/OP AGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />⢠<br />AUTOMOBILE <br />LIABILITY <br />7320-04-61 <br />07/01/2015 <br />07/01/2018 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />X <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />NON -OWNED <br />HIRED AUTOS X AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOYERS' LIABILITY Y / N <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? â <br />N / A <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Named insured includes Snowcap Coal Company,lnc. Covers all operations in the State of Colorado, X, C, U included. <br />Endorsement Cancellation Notice: <br />In the event we cancel this policy, we agree to mail prior written notice of cancellation to the name and address shown in the schedule below. The number of days of <br />advance notice of cancellation sent to the names shown in the schedule shall be equal to or greater than the statutory requirement and can never be less than the <br />mandated period. <br />Schedule <br />(continued next page) <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2014/01) <br />Page 1 of 2 © 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 />Division of Reclamation, Mining and Safety <br />AUTHORIZED REPRESENTATIVE <br />1313 Sherman Street - Room 215 <br />Denver, CO 80203 <br />United States <br />kA. <br />ACORD 25 (2014/01) <br />Page 1 of 2 © 1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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