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2020-07-31_GENERAL DOCUMENTS - C1981044
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2020-07-31_GENERAL DOCUMENTS - C1981044
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Last modified
8/3/2020 11:02:56 AM
Creation date
8/3/2020 6:06:50 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981044
IBM Index Class Name
General Documents
Doc Date
7/31/2020
Doc Name
Certificate of Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
RAR
JLE
Media Type
D
Archive
No
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Page 1 of 1 <br />RDS CERTIFICATE OF LIABILITY INSURANCE <br />ASO, <br />DATEE(MMI202 Y) <br />07/23//2020 <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 <br />Willis Towers Watson Southeast, Inc.P <br />c/o 26 Century Blvd <br />P.O. Box 305191 <br />CONTACT Willis Towers Watson Certificate Center <br />NAME: <br />_ _ _ <br />HONE 1-877-945-7378 aC 1-888-467-2378 <br />E-MAIL <br />ADDRESS: certificates@willis.com <br />INSURERS AFFORDING COVERAGE T NAIC# <br />Nashville, TN 372305191 USA <br />INSURER A: ACE American Insurance Company 22667 <br />CLAIMS -MADE X OCCUR <br />INSURER B: <br />INSURED <br />Peabody Energy corporation and Subsidiaries <br />— <br />701 Market street <br />INSURER C: <br />INSURER D: <br />Suite 700 <br />St. Louis, MO 631011826 <br />INSURER E <br />INSURER F: <br />COVERAGES CERTIFICATE NIIMRFR- W17339545 REVISION NUMRER- <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 />�AODL'SUIR' - - - - - - - .- - POLICY EFF POLICY EXPLIMITS <br />ILTR - <br />- - - <br />TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/D01YYYY <br />X COMMERCIAL GENERAL LIABILITY <br />EACHOCCURRENCE <br />$ 2,000,000 <br />CLAIMS -MADE X OCCUR <br />DAMAGE TO RCN ILL) <br />PREMISES LEa ocairrencel <br />$ 2,000,000 <br />A <br />MED EXP lAny one person) <br />$ <br />HDOG71451343 08/01/2020!08/01/2021, <br />PERSONAL &ADV INJURY <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />X POLICY PRO - <br />PRO- _ LOC <br />PRODUCTS - COMP%OPAGG <br />$ 2,000,000 <br />OTHER: <br />$ <br />AUTOMOBILE LIABILITY <br />__ _. <br />COMBINED SINGLE LIMIT <br />LEa accdenl). <br />$ 2,000,000 <br />X ANY AUTO <br />BODILY INJURY (Per person} <br />$ <br />A <br />OWNED SCHEDULED ISAH25310585 08/01/2020106/01/2021'' <br />BODILY INJURY (Peraccidenp; <br />$ <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />PROPERTY DAMAGE <br />$ <br />AUTOS ONLY AUTOS ONLY <br />(Per accident) <br />.$. <br />UMBRELLA UAB OCCUR <br />I <br />EACH000URRENCE <br />$ <br />EXCESS UAB i CLAIMS -MADE <br />AGGREGATE <br />$ <br />DED ^, RETENTION$ <br />i $ <br />WORKERS COMPENSATION <br />PER <br />ERH <br />AND EMPLOYERS' LIABILITY YIN <br />RR/TATUTE <br />ANYPROPRIETOPARTNEEXECU I IVC <br />I <br />E.L.ELEACH ACCIDENT <br />$ <br />OFFICER/MEMBEREXCLUDED? NIA <br />❑ <br />(Mandatory In NH) <br />I <br />E.L. DISEASE - EA EMPLOYEE! $ <br />II yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />t <br />i <br />DESCRIPTION OF OPERATIONS ! LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) <br />Moffat County Mining, LLC Including Permit C-81-044. <br />Ilelgil111l2lef_1 <br />Colorado Division of Reclamation Mining and Safety <br />1313 Sherman Street <br />Room 215 <br />Denver, CO 80203 <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 />AUTHORIZED REPRESENTATIVE <br />®1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />sit ID: 19901111 9ATcH: 1758394 <br />2 of 2 3544 <br />
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