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2013-06-17_GENERAL DOCUMENTS - C1981044
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2013-06-17_GENERAL DOCUMENTS - C1981044
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Entry Properties
Last modified
8/24/2016 5:21:29 PM
Creation date
6/17/2013 9:18:36 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981044
IBM Index Class Name
General Documents
Doc Date
6/17/2013
Doc Name
Certificate of Liability Insurance
From
Jerry Nettleton
To
DRMS
Permit Index Doc Type
Insurance
Email Name
ZTT
DIH
Media Type
D
Archive
No
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A66_ O_ CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 <br />10/29/2012 <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 />CONTACT <br />NAME <br />Willis of Tennessee, Inc. <br />c/o 26 Century Blvd. <br />P.O. Box 305191 <br />PHONE FAX <br />877- 945 -7378 888- 467 -2378 <br />E -MAIL certificates@willis.com <br />Nashville, TN 37230 -5191 <br />INSURER(S)AFFORDINGOOVERAGE <br />NAIC# <br />INSURERA:ACE American Insurance Company <br />22667 -001 <br />EACH OCCURRENCE <br />INSURED <br />Peabody Energy Corporation and Subsidiaries <br />INSURERB: <br />$ 100,000 <br />INSURERC: <br />X COMMERCIAL GENERAL LIABILITY <br />Attn: Robert Fenley <br />701 Market Street <br />Suite 700 <br />INSURERD: <br />INSURERE: <br />St. Louis, MO 63101 -1826 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 18784785 REVISION NUMBER: <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 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 />ILTR <br />TYPE OF INSURANCE <br />DD' <br />SUB <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />GENERAL LIABILITY <br />Y <br />HDOG2701351A <br />11/1/2012 <br />11/1/2013 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />PREMISESOEeocGureence <br />$ 100,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL& ADV INJURY <br />$ 5,000,000 <br />GENERAL AGGREGATE <br />$ 6,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />$ 6,000,000 <br />POLICY PRO LOC <br />JECT <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />ISAH0871194A <br />11/1/2012 <br />11/1/2013 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />5 000 000 <br />$ , , <br />BODILY INJURY(Per person) <br />$ <br />X ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY(Per accident) <br />$ <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />PROPERTYDAMAGE <br />(Per accident) <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />AND EMPLOYERS'LIABILITY YIN <br />ANY PROPRIETOR /PARTNER /EXECUTIVE ❑ <br />OFFICER /MEMBER EXCLUDED? <br />(Mandatory in NH) <br />I yes, describe under <br />NIA <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE- EA EMPLOYEE <br />$ <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE- POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I 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 />CERTIFICATE HOLDER CANCELLATION <br />Coll : 3905349 Tpl :1544835 Cert: l 4 85 ©1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <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 />Routt County <br />AUTHORIZED REPRESENTATIVE <br />136 Sixth Street <br />- <br />P.O. Box 773840 <br />Steamboat Springs, CO 80477 <br />Coll : 3905349 Tpl :1544835 Cert: l 4 85 ©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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