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2019-07-30_GENERAL DOCUMENTS - C1982057 (2)
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2019-07-30_GENERAL DOCUMENTS - C1982057 (2)
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Last modified
8/1/2019 10:30:49 AM
Creation date
8/1/2019 6:50:13 AM
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Template:
DRMS Permit Index
Permit No
C1982057
IBM Index Class Name
General Documents
Doc Date
7/30/2019
Doc Name
Certificate of Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
RAR
JDM
Media Type
D
Archive
No
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_ Page 1 of 1 <br /> III% O' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D2019 ) <br /> �,�. o7/zz/zo19 <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(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 Willis Towers Watson Certificate Center <br /> Willie of Tennessee, Inc. NAME: <br /> c/o 26 Century Blvd PHONE x 1-877-945-7378 AIC No: 1-888-467-2378 <br /> E-MAIL <br /> P.O. Box 305191 ADDRESS_certificates@willis.com <br /> Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC# <br /> GINSURER A: ACE American Insurance Company 22667 <br /> INSURED �� INSURER 8: <br /> Peabody Energy Corporation and Subsidiaries`_ Q INSURER C: <br /> 701 Market Street ,`\ <br /> Suite 700 J INSURER 0: <br /> St. Louis, MO 631011826 '►yJ•'`+, INSURER E: <br /> v INSURER F: <br /> COVERAGES CERTIFICAT R:W12091197 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 /> !NSR' ADDLTYPEOFINSURANCE INSD SUER POLICY NUMBER MMiDDmY MMLDIDIYYYY LIMITS <br /> LTR <br /> X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ <br /> 2,000,000 <br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence), ., -$__ 2,000,000 <br /> ; -- - <br /> A MED EXP(Any one person) $ <br /> HDOG71574003 08/01/2019108/01/202W PERSONAL&ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER j GENERAL AGGREGATE 1$- - 2,000,000 <br /> X POLICY JE u LOC ~PRODUCTS-COMPIOP AGG $ 2,000,000 <br /> OTHER $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 <br /> �Ea_accident)_ _-._ <br /> X <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> A OWNED SCHEDULED ISAM25302199 08/01/2019 08/01/2020! BODILY INJURY(Per accident),$ <br /> AUTOS ONLY AUTOS — <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY !Per accident) <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE I G© AGGREGATE 1$ <br /> DED ! RETENTION$ $ <br /> WORKERS COMPENSATION <br /> PER U1 H- <br /> AND EMPLOYERS'LIABILITYYIN (� STATUTE iER <br /> ANYPROPRIETORIPARTNERIEXECUTIVE `+ E L EACH ACCIDENT 1 $ <br /> OFFICER)MEMBEREXCLUDED? NIA <br /> (Mandatory In NH) -E.L.` A ���� DISEASE EA EMPLOYEE!$ <br /> II yes,describe under G �J` � <br /> DESCRIPTION OF OPERATIONS below R`G El DISEASE-POLICY LIMIT !$ <br /> I ! <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> Named Insured: Seneca Coal Company, LLC, a Subsidiary <br /> Covers operations at Seneca II-W Mine including damage from surface coal mine operations, the use of explosives and <br /> damage to water wells. <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 AUTHORIZED REPRESENTATIVE <br /> Room 215 <br /> 1313 Sherman Street <br /> Denver, CO 802032273 <br /> ®1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD <br /> SR IC: 18287549 HATCH: 1293074 <br /> 2 of 3 269 <br />
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