2017-08-02_GENERAL DOCUMENTS - C1981044

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Page 1 of 1 A`C�OQ® _ttl........../ /� CERTIFICATE OF LIABILITY INSURANCE DATE(MM//2017 ) O,i2„2D1, 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX 1-877-945-7378 1-888-467-2376 A/C N Ext): A/C No Willis of Tennessee, Inc. fMC c/o 26 Century Blvd P.O. Box 305191 0 2 2017 E-MAIL ADDRESS: certificates@willis.com INSURERS AFFORDING COVERAGE NAIC# Nashville, TN 372305191 USA AUG INSURER A: ACE American Insurance Company 22667 PREM SES EaEoccu ence $ 2.000, 000 „� INSURED DM'SI© Peabody Energy Corporation and Subsidiaries MINING AND SAFE„ INSURER B: PERSONAL &ADV INJURY $ 2,000,000 701 Market Street INSURER C: INSURER D: Suite 700 INSURER E St. Louis, MO 631011826 INSURER F: N COVERAGES CERTIFICATE NUMBER: W3096279 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 SUBR POLICY NUMBER EFF MM/ D/YYY POLICY P MM/ D/Y YLICY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR N N HDOG27870491 08/01/2017 08/01/2018 EACH OCCURRENCE $ 2,000,000 PREM SES EaEoccu ence $ 2.000, 000 MED EXP (Any one person) $ PERSONAL &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY F PRO JECT a LOC u OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY N N ISAH09062725 08/01/2017 08/01/2018 COMBINED SINGLE LIMIT $ 2,000,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVEF—]E OFFICER/MEMBEREXCLUDED9 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Moffat County Mining, LLC Including Permit C-81-044. r_FRTIFIC`ATF HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 14889283 B -CH: 397018 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Colorado Division of Reclamation Mining and Safety AUTHORIZED REPRESENTATIVE 1313 Sherman Street Room 215 Denver, CO 80203 ) fl C �f .hfcLCKl -i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 14889283 B -CH: 397018