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GENERAL56374
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Entry Properties
Last modified
8/24/2016 8:40:47 PM
Creation date
11/23/2007 11:23:54 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1980005
IBM Index Class Name
General Documents
Doc Date
7/10/1991
Doc Name
Certificate of Insurance
From
PEABODY COAL CO
To
MLR
Permit Index Doc Type
INSURANCE
Media Type
D
Archive
No
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L <br />~a1:lii:u. CERTIFICATE OF INSURANCE , . ISSUE DATE (MM/DD/YY) <br />' 6/20/91' <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br />Sedgw is k James CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE <br />~ DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />O} !Jew Englandi Inc. I POLICIES BELOW. ' <br />4u Broad Street COMPANIES AFFORDING COVERAGE <br />I Boston. t4a. 0[109 <br />I <br />coupaNv <br />Attn: Mary Garfagna LETTER A r,?tional Union =irc ?ns. Cc. <br />COMPaNV B <br />INSURED LETTER 'irmin5ham Flr° jns. Co. <br />Peabody Coal Co. CDMPA4Y C <br />Suzanne Luepke LETTER Lanom~rk ;nsur~nce Co. <br />301 North Memorial Crive coMPANr <br />St. Louis MO 5?166 LETTER D <br />CDMPANY E <br />LETTER <br />COVERAGES <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 ANV REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAV BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. <br />E%CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. <br />CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION (DD D ,L1~.1~5 <br />LTR DATE IMMIDDIYY) DATE IMM/pDIV Y) <br />A GENERAL LIABILITY (j L 2 4 S e 7 (~ 7 1/ G 1/ 91 10 / L 1/ 91 GENERAL AGGREGATE S 1 j D (~ <br />X COMMERDIAIGENERALLIABILITY GL249870P (NJ) PROOUCTS~COMPIOPAGG. S 1500 <br />CLAIMS MADE ~( OCCUR. FLTX~493709 (TX) pERSONAL6ADV. INJURY S 1000 <br />OWNER'S 8 CONTRACTOR'S PROT EACH OCCURRENCE S 1 D C, n <br />.( Broad Form Vendors Coverage Incjuaei FIRE DAMAGE (Any one lire) S 5!~ <br />~ MED. E%PENSE (My one penonl S <br />I A gUTOMOBIIE LIABILITY C A S ~` L 9 0 2? ~~ V 1/ 91 1 ~. / 01 / 91 COMBINED SINGLE S <br />X ANVAUro CA56296?4 (NJiNYi'+IA) LIMIT 1500 <br />` )( ALL OWNED AUTOS GA TX:529c25 C?J() BODILY INJURY S <br />IPer person) <br />I X SCHEDULED AUTOS <br />1 <br />~( HIRED AUTOS BODILY INJURY <br />~ )( NON-OWNED AUTOS IPer acnEanl) S <br />GARAGE LIABILITY <br />pROPERTV pAMAGE S <br />EXCESS LIABILITY EACH OCCURRENCE S <br />UMBRELLA FORM AGGREGATE S <br />OTHER THAN UMBRELLA FORM <br />WORKER'S COMPENSATION STATUTORY LIMITS <br />EACH ACCIDENT 3 <br />AND <br />pISEASE-POLICY LIMIT S <br />EMPLOYERS' LIABILITY <br />DISEASE-EACH EMPLOYEE S <br />I OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ~, ~ V: R S ALL O P E R A T I O N S I N C C L O R A D D i l <br />INCLUDING SEN.CA II MiiJE AND iNCLUDINii CAI4AGE FROM SURFACE GOAL MINE <br />OPcRATI0N5i THE USt GF EXPLOSIVcS AND DAMAGE TO WATER WELLS. <br />CERTIFICATE HOLDER CANCELLATION <br />C I V I S I ON 0 F MINED LAND ~C 1_ SHOULD ANV OF 7HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7HE 1 / <br />C L A M AT I0 N EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL RNOW(WRAXROC <br />COLORADO DEPT. CF NAT. R?S. MAIL '~DAVSWRITTENNOTICETOTHECERTIFICATEHOLDERNAMEDTOTHE <br />'.1 5 C cN T c N N I A L E L DC . LEFT. BUT FAILURE TO MAIL SUCH NOT ) TMPO$E NO; BIIGATION OR <br />1:13 ~Hc°MAN S7nEET p pap~Ny~I~g.Fpf~""' I "Q <br />_ LIABILITY OF ANV KIND UPON THE l.~ l'~L"Jl)T LI~~T ~REPij~fSENTATIVES. <br />DE!v V 7R I G G c+ U 23 ~ AUTHORIZED REPRESENTATIVE \ I~/1 <br />BY ,`ACA,-~S .~~ <br />' ACORD 25.5 (7/90) v ql nal„p/~CiQ:l~4,~10 ORATION 1990 <br />O 7 _ _ <br />
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