2009-05-26_GENERAL DOCUMENTS - C1980005

• Permit No: C1980005
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 5/26/2009
• Doc Name: Certificate of Liability for MR60 Geotechnical Drilling
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: DTM
• Media Type: D
• Archive: No

ACCW?°® CERTIFICATE OF LIABILITY INSURANCE F
Page 1 of 2 05;20/2 p
PRODUCER 877-945-7378 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Willis of Tennessee, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
26 Century Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. Box 305191
Nashville, TN 37230-5191 INSURERS AFFORDING COVERAGE NAIC#
INSURED Peabody Energy Corporation and Subsidiaries INSURERA:National Union Fire Insurance Company 19445-011
Attn: Ryan Brown

701 Market Street INSURERB:
Suite 700 INSURERC:
St. Louis, MO 63101-1826
INSURER D:
INSURER E:
ULJVtKA(3tJ
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR DD'
NSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE MM/DD/YYYY POLICY EXPIRATION
DATE MMIDDIYYYY
LIMITS
A GENERAL LIABILITY GL4807243 11/1/2008 11/1/2009 EACHOCCURRENCE $ 2,000,000
- - MEReIALGENERAL-LIABILITY_ DAMAGE TO RENTED
PREMISES Ea occuran.
$
100
000
t CLAIMS MADE 7 OCCUR _
MED EXP (Any one person) _
_
$ ?5,000
PERSONAL&ADV INJURY $ 1
000
000
1
,
GENERALAGGREGATE S 4
000
000
,
,
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 4,000,000
POLICY PRO-
JECT LOC
A AU TOMOBILE LIABILITY CA4806729 11/1/2008 11/1/2009

][

ANY AUTO COMBINED SINGLE LIMIT

(Ea accident) ident)
$ 2,000,000
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
• BODILY INJURY $
NON-OWNED AUTOS (Per accident)

? /c PROPERTY DAMAGE $
M G
o (Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO U' ?o EA ACC
OTHERTHAN $
f AUTO ONLY: AGG $
EXCESS/ UMBRELLA LIABILITY ision •'Vz
?' •
i ( EACH OCCURRENCE $
OCCUR CLAIMS MADE v
D
M+jtin9 and AGGREGATE $

DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION WC STATU-
OTH-

AND EMPLOYERS' LIABILITY LIMITS ER
TORY
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE? E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
i
- -` - -

-- _ - -

--_ -
-

- - - -
- -
E.L. DISEASE - EA EMPLOYEE
$
Ifyyet6de
s ibeunder
SPECIALPROVISIONSbelow - - E.L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Named Insured includes: Sage Creek Coal Company, LLC
It is agreed that Colorado Division of Reclamation, Mining and Safety is included as an Additional
Insured as respects to General Liability where required by contract or agreement.
Colorado Division of Reclamation,
Mining and Safety
1313 Sherman Street, Room 215 A
Denver, CO 80203 I
ACORD 25 (2009/01) Coll:2705459 T-01:846378 Cert:l:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
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The ACORD name and logo are registered marks of ACORD