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2010-12-02_GENERAL DOCUMENTS - C1982056
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2010-12-02_GENERAL DOCUMENTS - C1982056
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Last modified
8/24/2016 4:27:31 PM
Creation date
12/3/2010 9:22:31 AM
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Template:
DRMS Permit Index
Permit No
C1982056
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
12/2/2010
Doc Name
Certificate of Liability Insurance (Emailed)
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JDM
Media Type
D
Archive
No
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AGENCY CUSTOMER ID: 236021 <br />LOC#: <br />ADDITIONAL REMARKS SCHEDULE <br />Paged of -2 <br />AGENCY NAMED INSURED <br /> Peabody Energy Corporation and Subsidiaries <br />Willis of Tennessee, Inc. Attn: Ryan Brown <br />POLICY NUMBER 701 Market Street <br /> Suite 700 <br />See First Page St. Louis, MO 63101-1826 <br />CARRIER NAIC CODE <br />ACE American Insurance Company 22667-001 EFFECTIVEDATE: See First Page <br />AUDI I TONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />It is agreed that Colorado Division of Reclamation, Mining and Safety is included as an Additional <br />Insured as respects to General Liability, but solely in regards to work being performed by or on <br />behalf of the Named Insured. <br />AV-UKUIU7(LUUUIU7) C011:3169066 Tpl:1174341 Cert:14953866 ©2008ACORDCORPORATION. Allrights reserved. <br />The ACORD name and logo are registered marks of ACORD
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