2018-08-08_PERMIT FILE - C1982056 (10)

Home Browse Search

^ Page 1 of 2 AC lO® DATE(MM/DD/YYYY ^ CERTIFICATE OF LIABILITY INSURANCE oe/25/2017 CHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE 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: Willis of Tennessee, Inc. c/o 26 Century Blvd fAJC,PHONNo,E X 1-877-945-7378 aC No: 1-888-967-2378 E-MAIL m P.O. Box 305191 ADDRESS: certificates@will is.com, Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Underwriters at Lloyd's London 15792 Peabody Energy Corporation 701 Market Street INSURER C: Suite 700 INSURER D: St. Louis, MO 631011826 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:W3331000 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MMIDDIYVYY X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 2,000,000 DA AGE TENTED CLAIMS-MADE F -- OCCUR PREM SES a occurrence) $ 2,000,000 A MED EXP(Any one person) $ Y HDOG27870491 08/01/2017 08/01/2018 PERSONAL&ADV INJURY $ 2,000,000 GEMLAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY 1 PRO JECT F7LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTo BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B X UMBRELLALIABX OCCUR EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE B080117743U17 08/01/2017 08/01/2018 AGGREGATE $ 3,000,000 DED I X I RETENTION$25,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' ❑ NIA (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E L"DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 102,Additional Remarks Schedule,maybe attached if more space is required) This Voids and Replaces Previously Issued Certificate Dated 07/27/2017 WITH ID: W3096285. RE: Twentymile Coal, 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 Twentymile Coal, LLC including CERTIFICATE HOLDER CANCELLATION 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 orado Division of Reclamation, Mining and Safety 3 Sherman Street, Room 215 Denver, CO 80203 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 14988031 HATCH: 426354