2010-12-02_GENERAL DOCUMENTS - C1982056

• Permit No: C1982056
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 12/2/2010
• Doc Name: Certificate of Liability Insurance ‎(Emailed)‎
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: JDM
• Media Type: D
• Archive: No

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A? °® CERTIFICATE OF LIABILITY INSURANCE
10/28/2 0
page
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies V require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement h
PRODUCER ? CONTACT
Willis of Tennessee, Inc. ,?& n 1o
o PHONE FAX
- 877-945-7378 888-467-2378
26 Century Blvd. ??l
P. O. Box 305191 EAnnRES -MAIL [e-mail]
Nashville, TN 37230-5191 C• ;'
'
INSURER(S)AFFORD ING COVERAGE
NAIC#
•-? INSURER A: ACE American Insurance Company 22667-001
INSURED INSURERS:
Peabody Energy Corporation and Subsidiaries
Attn: Ryan Brown INSURER C:
701 Market Street
INSURERD:
Suite 700
St. Louis, MO 63101-1826 INSURER E:

INSURER F:
RAGES CERTIFICATE NUMBER: 14953866 REVISION NUMBER:
COVE
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INDICATED
.
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE DD' SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS
GENERAL LIABILITY Y N HDOG2552536A 11/1/2010 11/1/2011 EACHOCCURRENCE $ 5,000,000
A X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurence $ 100,000
CLAIMS-MADE OCCUR MED EXP (Any one person) $ 5 000

PERSONAL& ADV INJURY $ 5,000,000
GENERAL AGGREGATE $ 6 000 00,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 6 000 000

POLICY PRO- I LOC $
A AUTOMOBILELIABILITY N N ISAH08631992 11/1/2010 11/1/2011 COMBINEDSINGLELIMIT
(Ea accident) 5, 000, 000
$
X ANY AUTO BODI LY INJURY(Per person) $
ALL OWNED
UTOS SCHEDULED
AUTOS
BODILY INJURY(Per accident)
$
A NON-OWNED DAMAGE
Pe O
a
E
de $
HIRED AUTOS AUTOS nt
r
c
a
$
UMBRELLALIAB OCCUR EACH OCCURRENCE $
H
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$

DED RETENTION $ $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
F
OFFICER/MEMBER EXCLUDED? N/A
E.L. DISEASE - EA EMPLOYEE
$
f Mandatory In NH)
f yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101, Additonal Remarks Schedule, If more space is required)
Re: Foidel Creek Mine, C1982-056
The insurer will notify the Division of substantial changes in policy, including or failure to
renew.
Covers operations including damage from surface coal mine operations, the use of explosives and
damage to water wells.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Colorado Division of Reclamation, Mining and Safety
313 Sherman Street, Room 215
Denver, CO 80203
Coll :3169066 Tp1:1174341 Cert:1 3 66 ©1988-2010ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD