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2019-07-30_GENERAL DOCUMENTS - M1978315 (3)
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2019-07-30_GENERAL DOCUMENTS - M1978315 (3)
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Last modified
12/18/2024 8:04:51 AM
Creation date
8/2/2019 12:30:22 PM
Metadata
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Template:
DRMS Permit Index
Permit No
M1978315
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
7/30/2019
Doc Name
Certificate of Insurance
From
Willie of Tennessee/Peabody Energy
To
DRMS
Email Name
PSH
Media Type
D
Archive
No
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o � <br /> "?o q-7"t3 �� Page 1 of 1 <br /> A`CO/R" CERTIFICATE OF LIABIL DD <br /> ITY INSURANCE D07/22r/2019Y) <br /> ATE I <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 /> PRODUCER CONTACT NAME: Willis Towers Watson Certificate Center <br /> Willis of Tennessee, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 <br /> c/o 26 Century Blvd A/C No <br /> P.O. Box 305191 ADDRESS: certificates@willia.com <br /> Nashville, TN 3 72 30 51 91 USA INSURERS AFFORDING COVERAGE NAIC k <br /> INSURER A: ACE American insurance Company 22667 <br /> INSURED <br /> Peabody Energy Corporation INSURER B: _- __ — <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:W12091199 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 /> LTR TYPE OF INSURANCE ADDL;SUBR POLICY EFF POUdY EXP <br /> POLICY NUMBER MMIDIYYYYY MMIDD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> CLAIMS-MADE X OCCUR 2,000,000 <br /> -_. l $PREMISES-Ea occurrence) _._ <br /> A MED EXP(Any one person) $ <br /> HDOG71574003 08/01/2019 08/01/2020 PERSONAL BADVINJURY 1 $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY PRO- <br /> JECT2,000,000 LOC PRODUCTS-COMPiOP AGO 1 $ <br /> OTHER ! $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> I (Ea accident) -----_--- <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 /> UMBRELLA LIAR <br /> OCCUR EACH OCCURRENCE_ Is <br /> EXCESS LIAR CLAIMS-MADE I AGGREGATE 1$ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION H- 1 <br /> AND EMPLOYERS'LIABILITY YN STATUTE <br /> $ <br /> ANYPROPRIETORP NIA E L EACH ACCIDENT <br /> ARTNERlEXECUTIVE � I <br /> OFFICERrMEMBEREXCLUDED? <br /> (Mandatory In NH) E L DISEASE-EA EMPLOYEE$_ <br /> II yes,describe under --- --—"-"'— <br /> DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RECEIVED <br /> JUL 3 0 2019 <br /> "ON OF RECLAMATION <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 Division of Mining s Safety AUTHORIZED REPRESENTATIVE <br /> 1313 Sherman Street, Ste 215 III <br /> Denver, CO 80203 <br /> 01988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> sit ID: 18287549 6ATcH: 1293074 <br /> 2 of 2 263 <br />
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