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2018-01-31_PERMIT FILE - C2009087 (9)
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2018-01-31_PERMIT FILE - C2009087 (9)
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Entry Properties
Last modified
3/9/2018 9:06:20 AM
Creation date
3/9/2018 9:04:16 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C2009087
IBM Index Class Name
Permit File
Doc Date
1/31/2018
Doc Name
Insurance Certificate
Section_Exhibit Name
Exhibit 2.03.9-E1 Insurance Certificate
Media Type
D
Archive
No
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Page 1 of 2 <br /> ® DATE(MM/DD/YYYY) <br /> ��. CERTIFICATE OF LIABILITY INSURANCE 08, <br /> A�� 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 /> ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les)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 CONTACT <br /> NAME: <br /> Willis of Tennessee, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 <br /> c/o 26 Century Blvd N Ex A/C No: <br /> E-MAIL certificates@willis.com <br /> P.O. Box 305191 ADDRESS: <br /> Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC# <br /> INSURERA: ACE American Insurance Company 22667 <br /> INSURED INSURER B: Underwriters at Lloyd's London 15792 <br /> Peabody Energy Corporation <br /> 701 Market Street INSURER C: <br /> Suite 700 INSURER D• <br /> St. Louis, MO 631011826 <br /> INSURER E <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 ADDL SUBR POLICY EFF LIMITS <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> ��� DAMAGE TO RENTED 2,000,000 <br /> CLAIMS-MADE -- OCCUR PREMISES Ea occurrence $ <br /> A MED EXP(Any one person) $ <br /> y HDOG27870491 08/01/2017 08/01/20182,000,000 <br /> PERSONAL 8 ADV INJURY $ <br /> GENI AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> u JECT <br /> $ <br /> OTHER <br /> AUTOMOBILE LIABILITYacccdentSINGLELIMIT $ <br /> (Ea <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> r $ <br /> X UMBRELLA LIAB �X OCCUR EACH OCCURRENCE $ 3,000,000 <br /> B y B080117743U17 08/01/2017 08/01/2018 3,000,000 <br /> EXCESS LIAB I CLAIMS-MADE AGGREGATE $ <br /> DED x RETENTION$25,000 $ <br /> WORKERS COMPENSATION STATUTE OERH <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E L EACH ACCIDENT $ <br /> D <br /> OFFICER/MEMBER EXCLUDE <br /> (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ <br /> I <br /> DESCRIPTION OF OPERATIONS/LOCATIONS(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 /> CERTIFICATE HOLDER CANCELLATION <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 /> lorado Division of Reclamation, Mining and Safety )) <br /> 1313 Sherman Street, Room 215f,/ <br /> Denver, CO 80203 {�1 4 t' '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 /> sa ID: 14988031 BATCH: 426354 <br />
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