My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2017-10-31_REVISION - C1982056
DRMS
>
Day Forward
>
Revision
>
Coal
>
C1982056
>
2017-10-31_REVISION - C1982056
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/1/2017 7:59:29 AM
Creation date
11/1/2017 7:50:06 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1982056
IBM Index Class Name
Revision
Doc Date
10/31/2017
Doc Name
Application
From
Twentymile Coal, LLC
To
DRMS
Type & Sequence
RN7
Email Name
TNL
DIH
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
12
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
Page 1 of 2 <br />ACORN® <br />CC) CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />08/25/2017 <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />NAME: <br />PHONE 1-877-945-7378FAX 1-888-467-2378 <br />No <br />Willis of Tennessee, Inc. <br />c/o 26 Century Blvd <br />P.O.ertificates®willis.com <br />.O. Box 305191 <br />EMAIL <br />ADDRESS <br />INSURERS AFFORDING COVERAGE NAIC# <br />Nashville, TN 372305191 USA <br />INSURER A. ACE American Insurance Company 22667 <br />EACH OCCURRENCE $ 2,000,000 <br />INSURED <br />INSURER B: Underwriters at Lloyd's London 15792 <br />Peabody Energy Corporation <br />701 Market Street <br />INSURER C: <br />INSURER D: <br />Suite 700 <br />INSURER E <br />St. Louis, MO 631011826 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: W3331000 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 I <br />LTR TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />X COMMERCIALGENERALLIABILITY <br />Denver, CO 80203 <br />t� _ ` <br />EACH OCCURRENCE $ 2,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RENTED 2,000,000 <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ <br />A <br />PERSONAL &ADV INJURY $ 2,000,000 <br />y <br />HDOG27870491 <br />08/01/2017 <br />08/01/2018 <br />GENERAL AGGREGATE $ 2, 000, 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS-COMP/OPAGG $ 2,000,000 <br />PRO- L� <br />POLICY JECT L—J LOC <br />$ <br />'OTHER <br />I AUTOMOBILE LIABILITY <br />EOacccdeDISINGLE LIMIT $ <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />�— OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />INJURY Y IN P <br />BDLJUer accident) <br />O I ( ) $ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE $ <br />Per acadent <br />$ <br />B <br />X UMBRELLA LIAB <br />1EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />B080117743U17 <br />08/01/2017 <br />08/01/2018 <br />EACH OCCURRENCE $ 3,000,000 <br />AGGREGATE $ 3,000,000 <br />DED I X 1 RETENTION $ 25, 000 <br />$ <br />WORKERSCOMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />STATUTE OERH <br />E L EACH ACCIDENT $ <br />E L DISEASE - EA EMPLOYEE $ _ <br />OFFICER/MEMBER EXCLUDED F7 <br />(Mandatory in NH) <br />NIAJ <br />E L DISEASE - POLICY LIMIT $ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />I I i <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />This Voids and Replaces Previously Issued Certificate Dated 07/27/2017 WITH ID: W3096285. <br />RE: Twentymile Coal, LLC <br />It is agreed that Colorado Division of Reclamation, Mining and Safety is included as an Additional Insured as respects <br />to General Liability where required by contract or agreement. Covers operations at Twentymile Coal, LLC including <br />CFRTIFICATF HOLDER CANCELLATION <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SR ID: 14988031 BATCH: 426354 <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 />AUTHORIZED REPRESENTATIVE <br />Colorado Division of Reclamation, Mining and Safety <br />1313 Sherman Street, Room 215�1 <br />Denver, CO 80203 <br />t� _ ` <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SR ID: 14988031 BATCH: 426354 <br />
The URL can be used to link to this page
Your browser does not support the video tag.