2018-08-08_GENERAL DOCUMENTS - C2009087

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Page 1 of 1 / ® A� v CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 07/26/2018 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 N Ext: 1-877-945-7378 A/C No): 1-888-467-2378 Willis of Tennessee, Inc. c/o 26 Century Blvd P.O. Box 305191 E-MAIL ADDRESS: certificates@willis.com INSURERS AFFORDING COVERAGE NAIL# Nashville, TN 372305191 OSA INSURERA: ACE American Insurance Company 22667 INSURED INSURER B: Peabody Energy Corporation CLAIMS -MADE � OCCUR 701 Market Street INSURER C : INSURER D: Suite 700 INSURER E St. Louis, MO 631011826 INSURER F: A COVERAGES CERTIFICATE NUMBER: W6990351 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 POLICY EFF MM/DD POLICY EXP MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR PREM SES Ea occu enc $ 2,000,000 MED EXP (Any one person) $ A y RDOG 71209003 08/01/2018 08/01/2019 PERSONAL &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY a PET � LOC $ OTHER, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY L AUTOS ONLY PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACHEACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE GG�vF. DED I I RETENTION $ $ VV WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?NIAPSGI\0'(�� (Mandatory in NH) 8 yes, descnbe under DESCRIPTION OF OPERATIONS below Q1 R (� O ma A ea (et l H STATUTE ER E L. EACH ACCIDENT $ E L. DISEASE - EA EMPLOYEE $ E L. DISEASE - POLICY LIMIT $ 0`v\SM��`r9 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: Peabody Sage Creek Mining, LLC It is agreed that Colorado Division of Reclamation, Mining and Safety is included as an Additional Insured as respects to General Liability where required by contract or agreement. Covers operations at Peabody Sage Creek Mining, LLC including the use of explosives. CFRTIFICATF HOLDER CANCELLATION Colorado Division of Reclamation, Mining and Safety 1313 Sherman Street, Room 215 Denver, CO 80203 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 16501781 --H: 803455