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2021-07-13_GENERAL DOCUMENTS - C1981041
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2021-07-13_GENERAL DOCUMENTS - C1981041
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Last modified
7/13/2021 9:49:08 AM
Creation date
7/13/2021 9:31:23 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981041
IBM Index Class Name
General Documents
Doc Date
7/13/2021
Doc Name
Certificate of Insurance
From
Mc Griff
To
DRMS
Permit Index Doc Type
Insurance
Email Name
CCW
JDM
Media Type
D
Archive
No
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ACC)IIR130® DATE(MM/DDNYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 06/23/2021 <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 NTACT <br /> McGriff Insurance Services,Inc f+ '� NAME: <br /> PO Box 10265 &EIVE® (A//CNNo Ext: 800-476-2211 AXC No <br /> Birmingham,AL 35202 E-MAIL <br /> JUL <br /> ADDRESS: <br /> J U L- 1 3 ?021 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Old Republic Insurance Company 24147 <br /> INSURED WN OF RECLAMATION INSURER B <br /> American Electric Power Company,Inc and all SubMV <br /> 1 Riverside Plaza MINING AND SAFETY INSURER C: <br /> Columbus,OH 43215 <br /> INSURER D <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:S6B78G3C 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 /> INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS <br /> LTR INSD VI <br /> LTR NUMBER MM/DD/YYYY MWDDNYYY <br /> A X COMMERCIAL GENERAL LIABILITY MWZZ 316379 07/01/2021 07/01/2024 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGETO RENTED 1,000,000 <br /> X CLAIMS-MADE OCCUR PREMISES Ea occurrence $ - <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> X <br /> PRO- <br /> POLICY JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> 17OTHER $ <br /> A AUTOMOBILE LIABILITY MWTB 316377 07/01/2021 07/01/2024 COMBINED SINGLE LIMIT 1,000,000 <br /> Ea accident $ <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> X HIRED X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB HCLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED 'N/A <br /> (Mandatory in NH) E L DISEASE-E_A EMPLOYEE $_ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 1 $ <br /> $ <br /> $ <br /> $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Named insured includes Snowcap Coal Company,lnc. Covers all operations In the State of Colorado,X,C,U Included <br /> Endorsement Cancellation Notice* <br /> In the event we cancel this policy,we agree to mall prior written notice of cancellation to the name and address shown In the schedule below The number of days of <br /> advance notice of cancellation sent to the names shown In the schedule shall be equal to or greater than the statutory requirement and can never be less than the <br /> mandated period <br /> Schedule <br /> (continued next page) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OFTHE 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 <br /> 1313 Sherman Street-Room 215 AUTHORIZED REPRESENTATIVE <br /> Denver,CO 80203 <br /> United States <br /> Page 1 of 2 ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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