My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2013-07-30_GENERAL DOCUMENTS - C1981044
DRMS
>
Day Forward
>
General Documents
>
Coal
>
C1981044
>
2013-07-30_GENERAL DOCUMENTS - C1981044
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/24/2016 5:23:03 PM
Creation date
7/30/2013 8:37:59 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981044
IBM Index Class Name
General Documents
Doc Date
7/30/2013
Doc Name
Certificate of Liability Insurance (Emailed)
From
Jerry Nettleton
To
DRMS
Permit Index Doc Type
Insurance
Email Name
JDM
ZTT
DIH
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
A_oRO� CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 <br />0TI(MI 013 <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 />Willis of Tennessee, Inc. <br />c/o 26 Century Blvd. <br />c/o <br />P.O. Box 305191 <br />g77- 945 -7378 FAX <br />888- 467 -2378 <br />E -MAIL certificatesQwillis.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 />INSURER <br />$ 100,000 <br />INSURERC: <br />X COMMERCIAL GENERAL LIABILITY <br />Attn: Robert Fenley <br />701 Market Street <br />Suite 700 <br />INSURER D: <br />CLAIMS- MADEIX IOCCUR <br />INSURER E: <br />St. Louis, MO 63101 -1826 <br />INSURER F: <br />M ED EXP (Anyone person) <br />COVERAGES CERTIFICATE NUMBER: 20177800 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 />LTR <br />TYPE OF INSURANCE <br />DD' <br />SUB <br />WVD <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 />FREMISESOEaoccurence <br />$ 100,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS- MADEIX IOCCUR <br />M ED EXP (Anyone person) <br />$ 5,000 <br />PERSONAL &ADV INJURY <br />$ 5,000,000 <br />GENERALAGGREGATE <br />$ 6,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OPAGG <br />$ 6,000,000 <br />$ <br />POLICY PRO LOC <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 />BODILY INJURY(Per person) <br />$ <br />X ANYAUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY(Per accident) <br />$ <br />HIREDAUTOS NON -OWNED <br />AUTOS <br />PROPERTYDAMAGE <br />(Peraccident) <br />$ <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DIED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />WCSTATU- OTH- <br />AND EMPLOYERS'LIABILITY Y/N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE❑ <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />f yes, describe under <br />N/A <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/ LOCATIONS /VEHICLES (Attach Acord 101, Additonal Remarks Schedule, it more space is required) <br />This certificate voids and replaces all previously certificates <br />Named Insured includes Peabody Sage Creek Mining, LLC. <br />Covers operations in Routt and Moffat Counties, Colorado, and Carbon County, Wyoming, including <br />but not limited to damage from surface coal operations, the use of explosives, and damage to water <br />wells, as well as all activities permitted under county permit approvals. <br />See Attached: <br />CERTIFICATE HOLDER CANCELLATION <br />Coll:4168706 Tpl:1544835 Cert:2 177800 © 1988- 2010ACORD 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 Board of Commissioners <br />AUTHORIZED REPRESENTATIVE <br />136 Sixth Street <br />P.O. Box 773840 <br />Steamboat Springs, CO 80477 <br />!� <br />� <br />Coll:4168706 Tpl:1544835 Cert:2 177800 © 1988- 2010ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />
The URL can be used to link to this page
Your browser does not support the video tag.