Laserfiche WebLink
AGENCY CUSTOMER ID: <br />LOC #: <br />ACO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />NAMED INSURED <br />Willis of Tennessee, Inc. <br />Peabody Energy Corporation and Subsidiaries <br />701 Market Street <br />Suite 700 <br />POLICY NUMBER <br />See Page 1 <br />St. Louis, NO 631011826 <br />CARRIER <br />NAIC CODE <br />See Page 1 <br />See Page 1 <br />EFFECTIVE DATE: See Page 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />Covers operations in Routt and Moffat Counties, Colorado, and Carbon County, Wyoming, including but not limited to <br />damage from surface coal operations, the use of explosives, and damage to water wells, as well as all activities <br />permitted under county permit approvals. Covered operations/properties include: Mesa Gravel Pit - Peabody Sage Creek <br />Mining, LLC (M-82-036); Red Rock Gravel Pit - Peabody Sage Creek Mining, LLC (M-78-315); Seneca IIW and Yoast Mines - <br />Seneca Property, LLC (C-81-044), Hayden Gulch Loadout - Hayden Gulch Terminal, LLC (C-92-081); Sig Elk Property - <br />Cottonwood Land Holdings, LLC; Williams Fork Mines - Moffat County Mining, LLC (C-81-044); Foidel Creek Mine - <br />Twentymile Coal, LLC (C-82-056); Peabody Sage Creek Mine - Sage Creek Coal Company, LLC (C-09-087); Vista Ridge and <br />Associated Real Estate Holdings - Twentymile Coal, LLC; Shoshone Mine - Shoshone Coal, LLC (477); Related Exploration <br />and Development Activities. Covered entities include Peabody Energy Corporation and all associated subsidiaries <br />operating in the noted coverage areas. In addition, those state and county governments with regulatory authority over <br />the covered operations/properties are included as additional insured parties with respect to General Liability, where <br />required by contract or agreement. General Liability limits, as noted in the Certificate, apply to each covered <br />operation/property, and are restricted only as designated (i.e.: Each Occurrence or Any One Person ). County <br />Governments and/or County Commissioners are identified as an Additional Insured parties with respect to the General <br />Liability coverage, however this coverage is limited to their interest(s) in the operations and activities of the <br />Named Insured, and only for such terms and limits which are the lesser of the policies hereon, or the written <br />requirements and/or agreements between the Named Insured and the Certificate Holder(s). <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 14988031 BATCH. 476354 CERT: W3331001 <br />