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2011-10-28_GENERAL DOCUMENTS - C1981044
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2011-10-28_GENERAL DOCUMENTS - C1981044
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Last modified
8/24/2016 4:44:25 PM
Creation date
10/31/2011 9:19:40 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981044
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
10/28/2011
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JRS
SB1
Media Type
D
Archive
No
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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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADD'L <br />INSRC <br />SUBF <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MM/DD/YYYY1 <br />POLICY EXP <br />(MM/DD/YYYY1 <br />LIMITS <br />A <br />GENERAL LIABILITY <br />22667 -001 <br />INSURED <br />Peabody Energy Corporation and Subsidiaries <br />Attn: Robert Fenley <br />701 Market Street <br />Suite 700 <br />St. Louis, MO 63101 -1826 <br />HDOG25532016 <br />11/1/2011 <br />11/1/2012 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />$ 100, 000 <br />$ 5,000 <br />$ 5,000,000 <br />$ 6,000,000 <br />$ 6,000,000 <br />$ <br />X <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occurence) <br />MED EXP (Any one person) <br />PERSONAL &ADVINJURY <br />I <br />INSURER F: <br />CLAIMS -MADE <br />X <br />OCCUR <br />GENERAL AGGREGATE <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />7 POLICY <br />PRO- <br />JECT <br />JECT <br />LOC <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED <br />ISAH08692312 <br />11/1/2011 <br />11/1/2012 <br />(Eaaccden) INGLELIMIT <br />$ 5,000,000 <br />BODILYINJURY(Perperson) <br />$ <br />AUTOS <br />HIRED AUTOS <br />_AUTOS <br />SCHEDULED <br />NON -OWNED <br />AUTOS <br />BODILY INJURY(Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N <br />ANY PROPRIETOR/PARTNER/EXECUTIVEI I <br />- OFFICER/MEMBER EXCLUDED? <br />N/A <br />WC STATU- OTH- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT <br />$ <br />((Mandato in NH) <br />ff yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additonal Remarks Schedule, if more space is required) <br />BTU Empire Company, LLC Including Permit C -81 -044. P �� <br />OCT L8'i) l <br />r'ai.A nt h<eclamatiOfl. <br />A 9 Cr CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 <br />ATE(M / O 1 <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 INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)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 <br />Willie of Tennessee, Inc. <br />26 Century Blvd. <br />P. O. Box 305191 <br />Nashville, TN 37230 -5191 <br />CONTACT <br />NAME: <br />PHONE FAX 877- 945 -7378 (A,NO) 888- 467 -2378 <br />ADDRESS: certificates@willis.com <br />INSURER(S)AFFORDING COVERAGE <br />NAIC # <br />INSURER A: ACE American Insurance Company <br />22667 -001 <br />INSURED <br />Peabody Energy Corporation and Subsidiaries <br />Attn: Robert Fenley <br />701 Market Street <br />Suite 700 <br />St. Louis, MO 63101 -1826 <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />I <br />INSURER F: <br />- - <br />Colorado Division of Reclamation Mining and Safety <br />1313 Sherman Street <br />Room 215 <br />Denver, CO 80203 <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 />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2010/05) <br />AT E NUMBER: <br />CANCELLATION <br />• <br />I>Airairttl and Safety <br />Co11:3528438 Tp1:1352650 Cert:1 3040 © 1988- 2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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