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2022-08-15_GENERAL DOCUMENTS - C1981044
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2022-08-15_GENERAL DOCUMENTS - C1981044
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Last modified
8/15/2023 8:30:13 PM
Creation date
8/15/2023 1:16:53 PM
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Template:
DRMS Permit Index
Permit No
C1981044
IBM Index Class Name
General Documents
Doc Date
8/15/2022
Doc Name
Certificate of Insurance
From
Marsh/Moffat County Mining, LLC
To
DRMS
Email Name
HR1
MAC
Media Type
D
Archive
No
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AC"R"® DATE(MM/DD/YYYY) <br /> INSURANCEFCERTIFICATE OF LIABILITY08/08/2023 <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 <br /> MARSH USA LLC Marsh I U S Operations <br /> -- <br /> 540 W MADISON A/CNNo Ext: 866-966-4664 I FAX(A/C, <br /> CHICAGO,IF 60661 E-MAIL (A/C,No,. <br /> ADDRESS: StLouis CertRequest@)Marsh Com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> 82 INSURER A:National Union Fire Insurance_Comp of Pittsburqh,PA 19445 <br /> INSURED INSURER B:NIA N/A <br /> Peabody Energy Corporation -- <br /> Hayden Gulch Terminal,LLC INSURER C:Underwriters at Lloyd's of Lon on 15792 <br /> Atm 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-009884819-05 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 <br /> LTR IN POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY 7032448 08/01/2023 08/01/2024 EACH OCCURRENCE_ $ 1,000,000 <br /> CLAIMS-MADE � OCCUR DAMAGE RENTED 2,000,000 <br /> PREMISESS((Ea occurrence $ <br /> MED EXP(Any one person) $ _ 0 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER 2,000,000 <br /> PRO- GENERAL AGGREGATE $ <br /> X POLICY F� JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER $ <br /> A AUTOMOBILE LIABILITY 8682565 08/01/2023 08/01/2024 COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> SINGLE <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 60509BOWCN2351801 08/01/2023 08/01/2024 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 I I ER <br /> ANYPROPRI ETOR/PARTN ER/EXECUTI VE <br /> OFFICER/MEMBEREXCLUDED9 ❑ NIA <br /> E L EACH ACCIDENT $ <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/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Colorado Department of Natural Resources SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Division of Reclamation,Mining and Safety THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Room 215 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1313 Sherman Street <br /> Denver,CO 802032273 <br /> 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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