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2020-07-31_GENERAL DOCUMENTS - M1978315 (2)
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2020-07-31_GENERAL DOCUMENTS - M1978315 (2)
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Last modified
12/19/2024 7:28:57 AM
Creation date
8/3/2020 11:42:24 AM
Metadata
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Template:
DRMS Permit Index
Permit No
M1978315
IBM Index Class Name
General Documents
Doc Date
7/31/2020
Doc Name
Certificate of Insurance
From
Willis Towers Watson
To
DRMS
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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^ Page 1 of 2 <br /> DATE(MM:DD,YYYY) <br /> ACC7KL� CERTIFICATE OF LIABILITY INSURANCE 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 CONTACT Willis Towers Watson Certificate Center <br /> NAME: _ <br /> Willis Towers Watson Southeast, inc. PH ONE - 1-877-945-7378 AIA No; 1-888-467-2378 <br /> c/o 26 Century Blvd EMAIL Ext)- <br /> P.O. Box 305191 ADDRESS: certificates@Willis-com <br /> Nashville, TN 372305191 USA INSURER(S)AFFORDINGCOVERAGE —NAICk <br /> INSURERA: ACE American Insurance Company 22667 <br /> INSURED INSURER B: <br /> Peabody Energy Corporation and Subsidiaries - ---� - -- <br /> 701 Market street INSURERC: <br /> Suite 700 INSURERD: <br /> St. Louis, MO 631011826 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:W17339552 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 /> tLTR TYPEOFINSURANCE AODLSUAIR� - "- - POLICY EFF POLICY EXP LIMITS <br /> POLICY NUMBER MM/DD/YYYY MM+DD:YYYY <br /> X COMMERCIAL GENERAL LIABILITY '. EACH OCCURRENCE $ 2,000,000 <br /> DAMAGE O R ENTE D2,000,000 <br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence).. $ <br /> A MED EXP(Any one person) $ <br /> y HDOG71451343 08/01/2020 08/01/2021 PERSONAL 8 ADV INJURY $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> XI POLICY PRO LOC PRODUCTS-COMPOPAGG $ 2,000,000 <br /> _-__ JECT <br /> OTHER <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> A OWNED SCHEDULED ISAH25310585 08/01/2020 08/01/2021: BODILY INJURY(Per accident) <br /> 'S <br /> _ AUTOS ONLY AUTOS $ _— <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY (Per accident)- <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESSLIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION ; STATUTE ER <br /> ANO EMPLOYERS'LIABILITY Y/N I - -- <br /> ANYPROPRIETOR,PARTNER,'EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICE RIMEMBER EXCLUDED <br /> ? ❑ NIA ---- - - <br /> (Mandatory In NH) E.L.DISEASE"EA EMPLOYEE,$ <br /> II yes,describe under E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS below <br /> i <br /> DESCRIPTION OF OPERATIONS:LOCATIONS,VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) <br /> Additional Named Insureds as follows: <br /> Covers operations in Routt and Moffat Counties, Colorado, including but not limited to damage from surface coal <br /> operations, the use of explosives, and damage to water wells. Covered operations/properties include: Mesa Gravel Pit <br /> - Peabody Sage Creek Mining, LLC (M-82-036) ; Red Rock Gravel Pit - Peabody Williams Fork Mining, LLC (M-78-315) ; <br /> Seneca IIW and Yoast Mines - Seneca Property, LLC (C-92-057 6 C-94-082) , Hayden Gulch Loadout - Hayden Gulch Terminal, <br /> LLC (C-92-081) ; Williams Fork Mines - Moffat County Mining, LLC (C-81-044) ; Foidel Creek Mine - Twentymile Coal, LLC <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 Reclamation, Mining and safety, AUTHORIZED REPRESENTATIVE <br /> State Board of Land Commissioners <br /> 1313 Sherman Street, Room 215 <br /> Denver, CO 80203 - "R^�� '" '� C �r7 <br /> ©1988-2016 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> SR iD. 19901111 13ATCH: 1758394 <br /> 2 of 2 3543 <br />
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