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2022-08-09_GENERAL DOCUMENTS - C2009087
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2022-08-09_GENERAL DOCUMENTS - C2009087
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Last modified
8/11/2022 9:13:03 AM
Creation date
8/9/2022 9:52:31 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C2009087
IBM Index Class Name
General Documents
Doc Date
8/9/2022
Doc Name
Certificate of Insurance
From
MARSH USA Inc
To
DRMS
Permit Index Doc Type
Insurance
Email Name
TNL
JDM
Media Type
D
Archive
No
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A� ® DATE(MM/DD/YYYY) <br /> COO CERTIFICATE OF LIABILITY INSURANCE 08/03/2022 <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 <br /> MARSH USA INC Marsh I U S Operations <br /> 540 W MADISON PHONE 866 g66 4664 FAAic No): 212-948-0811 <br /> CHICAGO,IL 60661 f �r E-MAIL ADDRESS: q C StLouis.CertRe ues Marsh Conn <br /> SSmm INSURERS AFFORDING COVERAGE NAIC# <br /> 91 INSURER A:National Union Fire Insurance Comp.of Pittsburgh,PA 19445 <br /> INSURED l� INSURER B:N/A N/A <br /> Peabody Energy Corporation 1' Q <br /> Peabody Sage Creek Mining LLC �"� AT�Or1, INSURER C:Underwriters at Lloyd's of London 15792 <br /> Attn.Kala Collett G44M <br /> Gateway One Building p��I�SIpN OF R Y,M�r1�RA� INSURER D: <br /> 701 Market Street,Suite 700 G&SA INSURER E <br /> St Louis,MO 63101-1826 M►NON <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: CHI-009884727-03 REVISION NUMBER: 3 <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 /> INSRLICY EXP <br /> LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DD/YYYY POLICY EFF MM/DDfYYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY X 7032448 08/01/2022 08/01/2023 <br /> EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO CLAIMS-MADE El OCCUR PREMISES(Ea occur RENTED <br /> ) $ 2,000,000 <br /> MED EXP(Any one person) $ 0 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L 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 PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> X UMBRELLA LIAB X OCCUR B0509BOWCN2250874 08/01/2022 08/01/2023 EACH OCCURRENCE $ 1,000,000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) <br /> Re Peabody Sage Creek Mining,LLC <br /> Colorado Division of Reclamation,Mining and Safely is included as Additional Insured where required by written contract.No explosion,collapse or underground damage exclusion is included on the general liability <br /> policy <br /> CERTIFICATE HOLDER CANCELLATION <br /> Colorado Division of Reclamation, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Mining and Safety THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 1313 Sherman Street,Room 215 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Denver,CO 80203 <br /> AUTHORIZED REPRESENTATIVE <br /> 24� C Zl.�r� 49occ. <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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