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2012-10-17_GENERAL DOCUMENTS - C1981012
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2012-10-17_GENERAL DOCUMENTS - C1981012
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Last modified
8/24/2016 5:09:33 PM
Creation date
10/24/2012 8:26:18 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981012
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
10/17/2012
Doc Name
Certificate of Liability Insurance
To
DRMS
Permit Index Doc Type
Insurance
Email Name
LDS
DIH
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 <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />J <br />NAMED ABOVE FOR THE POLICY PERIOD <br />DOCUMENT WITH RESPECT TO WHICH THIS <br />HEREIN IS SUBJECT TO ALL THE TERMS. <br />I LTR . TYPE OF INSURANCE INSR <br />i w�O POLICY NUMBER <br />IMMIDD/YYYY1 <br />(MMIDD/YYYYI <br />LIMITS <br />1 GENERAL UA LrrY <br />I _ <br />B X COMMERCIAL GENERAL LIABILITY <br />77 <br />1 CLAIMS -MADE LXJ OCCUR <br />GL0011077 -02 <br />09/23/12 <br />09/23/13 <br />EACH OCCURRENCE <br />S 1,000,000 <br />DAMAGE TO R ENTED <br />PREMI s e • - - <br />s 100,000 <br />MED E)P (Any one person) S 6,000 <br />_ ____ _ <br />PERSONAL aADVINJURY 1,000,000 <br />, X . Pollution 1 mill <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />' GENL AGGREGATE LIMIT APPLIES PER <br />F ..— PRO- Fl ; X ; POLICY ' I JFCT LOC <br />PRODUCTS - COMPIOP AGG <br />S 2,000,000 <br />$ <br />AUTOMOBILE LIABILITY <br />NI <br />V <br />f� L <br />1 O �t� 1 L <br />�� ` zN `�r, <br />COOMBI LIMIT <br />E <br />1 ANY AUTO <br />~ . ALL OWNED I SCHEDULED <br />• AUTOS AUTOS <br />II HIRED AUTOS 1_I AUTOS ED <br />) I <br />BODILY INJURY (Per pern) <br />borsch) <br />S <br />I <br />BODILY INJURY (Per accident) <br />S <br />PROPERTY DAMGE <br />accident) A <br />a <br />$ <br />- -- ' EXCESS LlAB B I OCCUR <br />I- - -. -- _ J CS-MADE <br />O �ReC;Sa { e � <br />\iSs { <br />C� ` 00 <br />EACH OCCURRENCE <br />AGGREGATE <br />i) <br />r <br />` ' DED i I RETENTIONS <br />S <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />1 <br />N 1 A <br />INC STATU- OTH- <br />TORY LIMITS FR <br />E.L EACH ACCIDENT <br />S <br />ANY PROPRIETOR/PARTNERIEXEC{JTIVE <br />i OFFICER/MEMBER EXCLUDED'+ 1 l <br />E.L DISEASE - EA EMPLOYEE <br />S <br />$ <br />(Mandatory In NH) <br />I n describe der <br />1 DESC under <br />RIPTION OF OPERATIONS below <br />- <br />E L DISEASE - POLICY LWIT I <br />A (Equipment Floater 1 � <br />ILM0300530 (EQUIPMENT) 12/08/11 <br />12/01Y12 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS/ VEHICLES (AMach <br />Re: Golden Eagle, Lore:ncito, and <br />ACORD 101, Addltlonel Remrlce Schedule, <br />New Elk Mines. <br />Emcee space Is required) <br />0— Mai -0 12 <br />NEWEL -2 OP ID: MW <br />CERTIFICATE OF LIABILITY INSURANCE 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 pollcy(ies) must be endorsed. If SUBROGATION 1S 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 Ileu of such endorsement(s). <br />PRODUCER <br />Peoples Insurance Agency LLC <br />PO Box 991 <br />Ashland, KY 41105 <br />J. Michael Wellman <br />INSURED New Elk Coal Co. LLC <br />12250 State Highway 12 <br />Weston, CO 81091 -9520 <br />COVERAGES <br />CERTIFICATE HOLDER <br />ACORD 25 (2010/05) <br />CERTIFICATE NUMBER: <br />606 - 329 -2200 <br />606 -325 -7787 <br />CONTACT <br />NAME: <br />PHONE Ex1Y. <br />ADDRESS: <br />INSURER A : RU Insurance Co. <br />lemma; B :Star Insurance Co <br />INSURER C: <br />INSURER D : <br />INSURER E <br />INSURER F <br />CANCELLATION <br />INSURER(S) AFFORDING COVERAGE <br />REVISION NUMBER: <br />DATE (MMIDOMYYYl <br />10/17/12 <br />FAX -- <br />(A/C, Nol: <br />NAIC t/ <br />Colorado Div of Reclamation, <br />Mining, & Safety <br />1313 Sherman Street <br />Room 215 <br />Denver, CO 80203 <br />COLOR -3 <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 POLN:Y PROVISIONS. <br />AUTHOR/ZED REPRESENTATIVE <br />® 1988 -2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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