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2018-09-26_GENERAL DOCUMENTS - C1981041
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2018-09-26_GENERAL DOCUMENTS - C1981041
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Last modified
9/27/2018 11:55:06 AM
Creation date
9/27/2018 9:26:02 AM
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Template:
DRMS Permit Index
Permit No
C1981041
IBM Index Class Name
General Documents
Doc Date
9/26/2018
Doc Name
Certificate of Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
CCW
Media Type
D
Archive
No
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DATE MM DD YYYY <br />A o CERTIFICATE OF LIABILITY INSURANCE 06 28 2018 <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 />PRODUCERAC <br />NAME <br />MCGRIFF SEIBELS WILLIAMS INC PHONE FAX <br />P O Box 10265 AICC No <br />gp0 476 2211Ext A C No <br />Birmingham AL 35202 E MAILADDRESS <br />INSURER S AFFORDING COVERAGE NAIC <br />INSURER A ACE American Insurance Company 22667 <br />INSURED INSURER B <br />American Electric Power Company Inc and all Subsidiaries <br />1 Riverside Plaza INSURER C <br />Columbus OH 43215 <br />INSURER D <br />INSURER E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER D8JU3N6Y 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 <br />TYPE OF INSURANCE <br />ADD SUBR POLICY EFF POLICY EXP <br />LTR INSD WVD POLICY NUMBER MMIDD MM DD LIMITS <br />X COMMERCIAL GENERAL LIABILITY <br />HDO G71097055 07 01 2018 07 01 2021 EACH OCCURRENCE 1 000 000 <br />DAMAGETORENTED <br />X CLAIMS MADE OCCUR PREMISES Ea occurrence <br />1 000 000 <br />MED EXP Anyone person <br />PERSONAL ADV INJURY 1 000 000 <br />GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2 000 000 <br />X POLICY <br />PRO <br />LOC PRODUCTS COMP OPAGG 2 000 000 <br />JECT <br />OTHER <br />A AUTOMOBILE LIABILITY ISA H25159792 07 01 2018 07 01 2021 COMBINED SINGLE LIMIT 1 000 000Eaaccadent <br />X ANY AUTO BODILY INJURY Per person <br />OWNED SCHEDULED BODILY INJURY Per accident <br />AUTOS ONLY AUTOS <br />HIRED NON OWNED PROPERTY DAMAGEXAUTOSONLYXAUTOSONLYPeraccidentI <br />UMBRELLA LIABOCCUR EACH OCCURRENCE <br />EXCESS LIAB CLAIMS MADE AGGREGATE <br />DED RETENTION <br />v <br />WORKERS COMPENSATION PER OTH <br />AND EMPLOYERS LIABILITY YIN1 <br />TAME ER <br />ANY PROPRIETOR PARTNER EXECUTIVE <br />a <br />E L EACH ACCIDENT <br />OFFICER MEMBER EXCLUDED N A v O <br />Mandatory in NH S am E L DISEASE FA EMPLOYEE <br />If yes describe under <br />DESCRIPTION OF OPERATIONS below O d e E L DISEASE POLICY LIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101 Additional Remarks Schedule may be attached if more space Is required <br />Named insured includes Snowcap Coal Company inc Covers all operations in the State of Colorado X C U included <br />Endorsement Cancellation Notice <br />In the event we cancel this policy we agree to mail prior written notice of cancellation to the name and address shown in the schedule below The number of days of <br />advance notice of cancellation sent to the names shown In the schedule shall be equal to or greater than the statutory requirement and can never be less than the <br />mandated period <br />Schedule <br />continued next page <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 />Colorado Department of Natural Resources <br />Division of Reclamation Mining and Safety <br />1313 Sherman Street Room 215 AUTHORIZED REPRESENTATIVE <br />Denver CO 80203 <br />United States <br />Page 1 of 2 1988 2015 ACORD CORPORATION All rights reserved <br />ACORD 25 2016 03 The ACORD name and logo are registered marks of ACORD
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