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2013-02-25_REVISION - C1981044
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2013-02-25_REVISION - C1981044
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Entry Properties
Last modified
8/24/2016 5:13:32 PM
Creation date
2/26/2013 8:22:07 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981044
IBM Index Class Name
REVISION
Doc Date
2/25/2013
Doc Name
Letter & Application
From
Moffat County Mining, LLC
To
DRMS
Type & Sequence
RN6
Email Name
ZTT
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 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 TR <br />TYPE OF INSURANCE <br />I <br />SUBR <br />POLICY NUMBER <br />POLICY ew <br />/ Mtivnnt P Y) <br />LIMITS <br />A <br />GENERAL <br />X <br />LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />INSURER B <br />HDOG2701351A <br />11/1/2012 <br />11/1/2013 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />PREMISES(Eaoccurence) <br />$ 100,000 <br />MEDEXP(Anyoneperson) <br />$ 5,000 <br />CLAIMS -MADE <br />X <br />OCCUR <br />PERSONAL B ADV INJURY <br />$ 5,000,000 <br />$ 6,000,000 <br />GENERAL AGGREGATE <br />PRODUCTS- COMP /OPAGG <br />$ 6,000,000 <br />$ <br />GEN'LAGGREGATELIMITAPPLIESPER <br />7 POLICY PRO- <br />IFrr <br />LOC <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL OWNED <br />AUTOS <br />HIRED AUTOS <br />SCHEDULED <br />AUTOS <br />NON-OWNED <br />AUTOS <br />ISAH0871194A <br />11/1/2012 <br />11/1/2013 <br />(Ea COMBINEDS INGLELIMIT <br />accdent) <br />$ 5,000,000 <br />BODILY INJURY(Per person) <br />$ <br />BODILYINJURY(Peraccident) <br />$ <br />E <br />(Per accident) <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />- <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />$ <br />DED RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/ N <br />ANY PROPRIETOR/PARTNER /EXECUTIVE <br />OFFICER/MEMBER EXCLUDED'? <br />`Mandatory in NH) <br />If yes, descnbe under <br />DESCRIPTION OF OPERATIONS below <br />N /A <br />I TORY MUS I I FR <br />E L EACH ACCIDENT <br />$ <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 />Covers all operations in Routt and Moffat Counties, Colorado, and Carbon County, Wyoming, including <br />damage from surface coal mine operations, the use of explosives, and damage to water wells. <br />All Activities permitted under County permit approvals. <br />Twentymile Coal, LLC, Colorado Yampa Coal Company, Shoshone Coal Corporation, BTU Empire <br />Corporation and Moffat County Mining, LLC. <br />AR ° ® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 <br />DATE 29/20 ' <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 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 />Willis of Tennessee, Inc. <br />c/o 26 Century Blvd. <br />P.O. Box 305191 <br />Nashville, TN 37230 -5191 <br />CONTACT <br />NAME <br />PHONE FAX <br />(Arc. No FxT) 877 - 945 -7378 (A/r. No) 888- 467 -2378 <br />E -MAIL <br />AnnRFFS certificates@willis.com <br />INSURER(S)AFFORDING COVERAGE <br />NAIC# <br />INSURERA 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 />I <br />INSURER B <br />INSURERC <br />INSURERD <br />INSURERE <br />INSURER F <br />COVERAGES <br />CERTIFICATE HOLDER <br />Routt County <br />136 Sixth Street <br />P.O. Box 773840 <br />Steamboat Springs, CO 80477 <br />CERTIFICATE NUMBER: 18784785 <br />CANCELLATION <br />REVISION NUMBER: <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 />/ Ai44'" ��� <br />Co11:3905349 Tp1:1544835 Cert:1 784785 © 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />
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