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2011-05-24_REVISION - C2009087 (3)
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2011-05-24_REVISION - C2009087 (3)
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Last modified
8/24/2016 4:33:47 PM
Creation date
5/27/2011 1:43:22 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C2009087
IBM Index Class Name
REVISION
Doc Date
5/24/2011
Doc Name
Revised Certificate of Insurance (Emailed)
From
DRMS
To
Jay James
Type & Sequence
SO1
Email Name
JDM
Media Type
D
Archive
No
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I- 'I <br />'°'% °r CERTIFICATE OF LIABILITY INSURANCE pas. 1 Of 3. 1 <br />5/23/41.20 <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 INSURERS), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If tlw cerK tats holder is an ADDITIONAL. INSURED, the policy(hwowst be endorsed. ff SUBROGATION IS WAIVED, sub jset to <br />the terms and condiflons ofthe policy, certain polities may require an endorsement. A statenwnton this cerffk ab does not toMer rights to the <br />cerdflcate holder In lieu of such endorsement(s). <br />PRODUCNm =:ACT <br />Millis of Tennessee, Inc. PHONE FAX <br />26 C <br />Bl <br />d jA&uhEx4 677-9il-7379 888-4 7-2376 <br />entury <br />v <br />. E-MAL <br />P. O. Dos 305191 <br />Nashville, TN 37230-5191 <br />CRIXNGCOVERAGE <br />NM# <br /> p RA. ACE AMriaan Insurance convany 22667-001 <br />pnltR® <br />INSURERS: <br />Peabody SaaW Corporation <br />Attn: Robert Penley INSURERC: <br />701 Market Street <br />700 <br />i <br />kNSUfERD: <br />Su <br />ts <br />St. Loris, NO 63101-1826 94SURERE <br /> 1 NSURERF: <br />cnvE AgES cF"MCATF NUMBER: 15994131 REVISION NUMBER:See Remarks <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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL. THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LIMITS SHOVM1 MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />Dw TYPEOFNISURANCE POLICYINIAreER POLICYEFF POLICYEXP Lam <br />A OEMERALUABLLRY Y RD002552536A 1/1/2010 11/1/2011 EACHOCCURREINCE S 5,000,000 <br /> COMMERCIAL GENERAL UABLLm i 100,000 <br /> CLAIMS-MADE© OCCUR MEDEXP are $ 5,000 <br /> PERSONAL & ADV INJURY S 5,000,000 <br /> GENERAL AGGREGATE S 6.000.000 <br /> GENtAGGREGATFLWRAPPLESPER: PRODUCTS-COrIPJOPAGG S 6,000,000 <br /> POLICY El -1= F? PRO- LOC <br /> AUTOMOBILE LIABLLnY da?ra LIWT f <br /> ANYAUTO SODLLYNNJURY(P'WVWK n) <br /> ?OOriNEO <br />I DOLED <br />[AUTOS BOOLLYINJURY(Pataoddmt) S <br /> HIREOAUTOS HOt?OYYNED ( <br /> $ <br /> UNDRELLAU" OCCUR EACH OCCURRENCE $ <br /> EXC186 UAS CLAIMS-WADE - <br />AGGREGATE t <br /> DED RETENTIONS $ <br /> woMMERSCOrATM1N 1??l 10a <br /> AMDBEW1fEWL1ABLL" <br />ANY PROPREFORIP'ARTN CUME <br />NIA <br />E.L.EACHAOCOENT <br />$ <br /> OFFICERIMEMBEREXCLUDED? ELD93EASE-EAEMPLOYEE S <br /> OFFOOPERATLDNSte. EL.O1SEASE-POUCYUMT S <br /> <br />DESCItlP MOFOMMMONSILOCATNONSIVEH=M{MhebAaad1M.AddkoWRanwoftSdrdts*YroNagmmb,o*ukod) <br />THIS VOIDS AM REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED: 10/28/2010 WITH IDs 14953947 <br />Re: Peabody Sage Creek Inning, LLC <br />It is agreed that Colorado Division of Reclamation, Dining and Safety is included as an Additional <br />Insured as respects to General Liability where repaired by contract or agreement. <br />lCovers onerationa Peabody Sage Crook Mining. LLC including the use of mmlosiveg. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE E)(PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Colorado Division of Reclamation, Mining and <br />1313 Sherman Street, Rook 215 <br />Deaver, CO 80203 <br />Co11:3368362 To111174314 Cart: <br />AUTHOROEDR SfarTATiVE <br />rights reserved <br />ACORD 25 (201 MM The ACORD name and logo are regIstered marfLS of ACORD
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