My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2021-01-27_REVISION - C1980007 (2)
DRMS
>
Day Forward
>
Revision
>
Coal
>
C1980007
>
2021-01-27_REVISION - C1980007 (2)
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/28/2021 7:19:56 PM
Creation date
1/28/2021 6:49:54 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980007
IBM Index Class Name
Revision
Doc Date
1/27/2021
Doc Name
Application
From
Mountain Coal Company, LLC
To
DRMS
Type & Sequence
RN8
Email Name
JDM
LDS
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
14
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
�C $' DATE (MMIDDIYYYY) <br />AC� CERTIFICATE OF LIABILITY INSURANCE 7i31i2021 7/30/2020 <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 Lockton Companies NAME cr <br />Three City Place Drive, Suite 900 PHONE FLAX He <br />St. Louis MO 63141-7081 E MAII <br />0" <br />(314)432-0500 ADDRESS: <br />INSURED Mountain Coal Company, LLC <br />1369402 5174 Highway 133 <br />Somerset CO 81434 <br />INSURERS AFFORDING COVERAGE NAIC # <br />_ INSURER A: National Union Fire Ins Co Pitts. PA 19445 <br />INSURER B : Aspen Specialty _ Insurance Company 10717 <br />INSURER C <br />INSURER D <br />INSURER E : <br />INSURER F : <br />nw�ewn�c� ennnn r00r101rnrc kil IaADCD• I1:I7I 4v1 RFVICIAN NIIMRFR• YY7t7C'S yy <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 TYPE OF INSURANCE AD L Sui3F1 MMD EFF POLICY EXP <br />LTR N WV POLICY NUMBER MMfO MM10 LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY N N 7032423 <br />CLAIMS -MADE I ^ I OCCUR <br />7/31/2020 <br />7/31/2021 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />PREMISES Eaoccua <br />$ 2 000 000 <br />MED EXP (Any oneperson) <br />$ I0 000 <br />X XCU & Subsidcncc PD <br />PERSONAL & ADV INJURY <br />$ 5,000,000 <br />X Gen AGG $25M <br />GENERAL AGGREGATE <br />$ 10 000 000 <br />_Policy <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />s S O0O O00 <br />POLICY 7JERG N LOC <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY NOT APPLICABLE <br />OMBfNED SINGLE LIMIT <br />Eaacci nt <br />$ XXXXXXX <br />BODILY INJURY (Per person) <br />$ XXXXXXX <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />$ XXXXX_Xx <br />OWNED SCHEDULED _ <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />pR g O'e'MA <br />$ XXXXXXX <br />$XXXXXXX <br />UMBRELLA LIAB OCCUR NOT APPLICABLE <br />EACH OCCURRENCE <br />$ XXXXXXX <br />AGGREGATE <br />$ XXXXXxX <br />EXCESS LIAB CLAIMS -MADE <br />$ .XXXXXXX <br />DED RETENTION $ <br />WORKERS COMPENSATION NOT APPLICABLE <br />AND EMPLOYERS' LIABILITY IN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ <br />STATUTE P777H <br />E.L. EACH ACCIDENT <br />$ XXXXXXX <br />E.L. DISEASE - EA EMPLOYE <br />$ XXXXXXX <br />OFFICERIMEMBER EXCLUDED? N / A <br />(Mandatory in NH) <br />E.L. DISEASE - POLICY LIMIT <br />$ XXXXXXX <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />B <br />Pollution Legal Liab - N N ERAHAF519 <br />Claims Made <br />711112119 <br />7/31/2021 <br />$1,000,000 per incident <br />S 1,000,000 policy aggregate <br />Sched. Locs <br />New Conditions <br />SIR -per policy <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) <br />COVERAGE IS INCLUDED FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS INCLUDING THE USE OF EXPLOSIVES. PERMIT <br />#C1980007 WEST ELK MINE <br />CLK I II-ICA I L MULUltiC OVV 11LL4V]1111%;&1L5 <br />12471681 <br />COLORADO DEPT. OF NATURAL RESOURCES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />DIVISION OF RECLAMATION MINING &SAFETY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />1313 SHERMAN STREET, ROOM 215 <br />DENVER CO 80203 <br />AUTHORIZED REPRESENTATIVE <br />U 1988-21[115 ACUKD GOKI'UKA I IUN. All rlgnts reserves. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
The URL can be used to link to this page
Your browser does not support the video tag.