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2021-08-16_GENERAL DOCUMENTS - C2009087 (4)
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2021-08-16_GENERAL DOCUMENTS - C2009087 (4)
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Last modified
8/17/2021 6:33:32 PM
Creation date
8/17/2021 8:14:14 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C2009087
IBM Index Class Name
General Documents
Doc Date
8/16/2021
Doc Name
Certificate of Insurance
From
Marsh USA
To
DRMS
Permit Index Doc Type
Insurance
Email Name
TNL
JDM
Media Type
D
Archive
No
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AC40R"® CERTIFICATE OF LIABILITY INSURANCE D08/04202DD >YYYY) <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 CONTANAME:CT Marsh I U S.Operations <br /> Marsh USA Inc <br /> 701 Market Street,Suite 1100 PHONEExile gg6-g66-4664A/c No): 212-948-0811 <br /> St.Louis,MO 63101 EMAIL StLouis CertRe ues Marsh.Com <br /> ADDRESS: Q <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> 326 INSURER A:National Union Fire Insurance Comp of Pittsburgh,PA 19445 <br /> INSURED INSURER B:N/A N/A <br /> Peabody Energy Corporation <br /> Seneca Coal Company,LLC INSURER C:Underwriters at Uo d's of London 15792 <br /> AUn Kala Collett <br /> Gateway One Building INSURER D <br /> 701 Market Street,Suite 700 INSURER E: <br /> St Louis,MO 63101-1826 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: CHI-009884828-02 REVISION NUMBER: 1 <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 SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY 7032448 08/0112021 08/01/2022 EACH OCCURRENCE $ 1,000,000 <br /> F-v-1 DAMAGE TO RENTED <br /> CLAIMS-MADE OCCUR PREMISES E.occurrence $ 1,000,000 <br /> MED EXP(Any one person) $ O <br /> PERSONAL 8 ADV INJURY $ 1,000,000 <br /> GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY❑ PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> JECT <br /> OTHER $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTYDAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> r i $ <br /> X UMBRELLA UAB X OCCUR B0509BOWCN2150734 08/01/2021 08/0112022 PEACHOCCURRENCE $ 1,000,000 <br /> EXCESS LIAB CLAIMS-MADE $ 1,000,000 <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION OTH- <br /> AND EMPLOYERS'LIABILITY Y/NE ERANYPROPRIETOR/PARTNER/EXECUTIVE CIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> State of Colorado SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> State Board of Land Comrrussloners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Recreabonal Lease State Trust Lands ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Room 620 <br /> 1313 Sherman Street <br /> Denver,CO 80203 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 />
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