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2011-01-12_GENERAL DOCUMENTS - C1992081
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2011-01-12_GENERAL DOCUMENTS - C1992081
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Entry Properties
Last modified
8/24/2016 4:28:50 PM
Creation date
1/12/2011 3:07:15 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1992081
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
1/12/2011
Doc Name
Insurance Document
From
Peabody
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JDM
Media Type
D
Archive
No
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A` °Rn® CERTIFICATE OF LIABILIT <br />t <br />Y INSURANCE page 1 of .1 lo <br />/2010 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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(les)must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br /> NAMF- <br />Willis of Tennessee, Inc. PHONE FAX <br />26 Century Blvd. (Atc-NO.EXT). 877-945-7378 8 -467 2378 <br />P. 0. Box 305191 E-R1AIL cartificates@williz.com <br />Nashville, TN 37230-5191 <br /> INSURERS FOROINGCOVERAGE NAIC(t <br /> INSURERA:ACE American Insurance Company 22667-001 <br />INSURER _'_._ . _..__ <br />Peabody Energy Corporation and Subsidiaries ----------- ------------ <br />INSURER B: <br />Attn: Ryan Brown INSURERC: <br />701 Market Street _.. --------...._-- <br />suite 700 INSURERD: --- <br />St. Louie, HO 63101-1826 INSURER E: <br /> INSURER F: <br />1_11ut K YI.F\ f'FR-I1Fr/?aTG N(IMRF?. 1 A tlCZOL I 15011101^11 111 It.betf. <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW (HAVE BEEN ISSUED TO THE INSURED NAMED A80VE 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 />EXCLU_S_ IONS_AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REUUCED BY PAID CLAIMS. <br />IN <br />I-TR SR <br />TYPE OF INSURANCE <br />DD' <br />SUB <br />] t pOLICYNUrdBER <br />POLICY OFF <br />POLICY EXP <br /> <br />LIMIT <br /> <br />S <br />• GENERAL LIABILITY N N HDO02552536A 11/1/2010 11/1/2011 gA <br />#OCCUR <br />RENCE <br />C S 51000,000 <br /> CO:R.IERCULLGENF.RALLWBILITY ! <br />RR <br />pp <br />PHE?EaE urD. $ 100,00() <br /> CIAtMS-MAOE© OCCUR MED EXP(Any one person) $ 51000 <br /> PERSOHALI4AOVINJURY _ S--_51000, 000 - <br /> <br /> _GEN'LAGGREGA_TELIMITAPPLIESPER: PRODUCTS-COMP"AGG S ._..0001000_ <br /> POLICY PRO- LOC S <br />A AUTOMOBILELUIOILiTY N N ISAH08631992 11/1/2010 11/1/2011 EaeoICEDSINGLELIUn S 5,000,000 <br /> X ANY AUTO BODILY I.NJURY(Perperson) $ <br /> ALLOWNED <br />AUTOS SCHEDULED <br />AUTOS <br />BODILY INJURY{PeteccidentI <br />5 <br /> HIREDAUTOS NON-OIYNED pOPEYYpAMAGE -? ------"-"-' <br /> _ AUTOS `Peraccidenq $ <br /> - S <br /> UMBRELLALIAB OCCUR EACHOCCURRENCE S <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE S <br /> DED RETENTIONS <br />. -_?----- <br />$ <br /> WORKERS COMPENSATION C A - I QT <br /> ANDEMPLOYERS'UABILITY y N <br /> ANY PROPRIETORIPARTNERIEXECUTIVE NIA E.L. EACH ACCIDENT <br /> <br />" <br />5 <br /> OFFICERJMEJSEREXCLUDE07 - - -- <br />-- <br /> landato .InR <br />I E.L.DiSSASE-EA EMPLOYEE <br /> y <br />ESC <br />RiIPPVONOFOPERATIONS boWit E.L.DISEASE -PotICYLIMIT $ <br /> <br />DESCRiPTtON OF OPERATIONS I LOCATIONS/VEHICLES (Attach Acord 101, Additonal Romarks S chedule, IF more space is required) <br />Named Insured: Hayden Gulch Terminal, Inc. <br />Covers operations at Hayden Gulch Loadoul Facility including damage from surface coal, etc., <br />Permit <br />C-92-081. <br />n 1,r-1\ ^4 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Colorado Department of Natural Resources <br />Division of Reclamation, Mining and safety AUTHORIZED REPRESENTATIVE <br />Room 215 <br />1313 Sherman Street <br />Denver, CO 80203-2273 / <br />Co11:3169066 TA1:1174341 Cert:1 <br />©1988-2010 ACORD CORPORATION. All rights reservsd. <br />ACORD 25 (2010/05) The ACORD dame and logo are registered marks of ACORD
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