Chesapeake-CS070329
ACORD
DA TE U'..~~,H1DiYY Y';i
P>;ODuCE.R (91&)493-H50 FAX
Meyers-Reynolds & Associates
1425 E. 7lst Street
Tulsa, OK 74136
(918)493-2395
CERTIFICATE OF LIABILITY INSURANCE
I
03/29/2007
THIS CERT!FICA TE IS ISSUED AS A MA TTER OF INFORMA TION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW
I
; NAIC /I
+----~--
Companyl
~-------
INSURERS AFFORDING COVERAGE
!;S-U-R'ED "Ches apeakeOperiting- Inc. ------~------
POBox 18496
Oklahoma City, OK 73154-0496
---~---~;;S~RER~be~Mutua1Ins-u ran c e
[INS1:'lER8 AEGIS Limited
!"'SURERC American Int'l Specialty Lines
t------
COVERAGES
THE POLICIES OF I,,"SURANCE LISTED BElO'N hAVE BEE"" ISSUED TO THE INSURED NAMED ABOVE FOR TCiE POLICY PERIOD INDICATED NOTVv1THSTANDING
ANY REOuIREMENT ~ER'v1 OR CONDITION OF A.NY CONTRACT OR O,HER DOCUMENT WITH RESPECf TO WHICH THiS CERTiFICATE MAY BE ISSUED OR
MilY PERTAIN THE INSURANCE AFFCRDED BY THE POLICIES OESCRIBED "EREIN 'S SUBJECT TO ALL ,HE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POL:C:ES A.GGREGATE LIMITS SHOWN MAY >-jAVE BEEN REDUCED BY PAID CLAIMS
l-iJjRT,;-OO TYPE OF INSURANCE POLICY "UMBER i POLICY EF~ECTlVE T POLICY EXPIRA TION
GENERAL LIABILITY SELF INSURED
Ix--l C,'=-;'MMERCI,w.l C;E~~ER::'L '-lABiliTY
~~r=] ClAi/o'S \lADE 0 OCCcJR
i-J ~-~-~--~
r--- ~ u_____
! GEN ,c..C~P~CATE ,1\1\:'" APPlfS PER
"--,
INSLRE R C,
:r~SURE R E
POLICy
AS1691522861036 07/01/2006
I
I
In--
AUTOMOBILE LiAB'LlTY
A
r\JO'".:=;'..\NEO Ai~ITDS
~f\.Y A'~ITO
A~L CN,,'NEC A',-,TOS
SC >~C)Ul::'::::' ='S
hlRlD :>'0TCS
GARAGE LIABILITY'
~ _At~y A ,-,I TO
~~_~~ E 5 5'U M8REL~_l!!, 8IL.'TY
~__J DCCcR L~ Cc,^,MS ','''''E
X0630AIA06! 07/01/2006
THE ATTACHEDI
I
SEE
B
L_
! ! CEO..JCTle~_E
X q~TU~TION
$ 1,000, OOQ
WOR<ERS COMPE~SA TlO~ AND
EMPLOYERS LIABILITY
WA169D522861066, 06/30/2006
ALL STATES EXCEPT I
S LF - INSURED IN W & OK!
PLC75548871 07/01/2005
A
Cu T~\iE
A';JY
C,f
oeS((I::€' lJ)::le:
Pr.<()\i':-.:,I:JNS telL".....
!PC;;li"ution L iabil i ty
C
LIMITS
EACH DCCURR[ NCE
I DAMAGE TC RENTED
~BEM!.S.ES ir:i'I IlcrlJr?n'-p.l
" MEO EXF (Any one P~{SOr)) $
r PERSON~.I_ & ADV "dUqy $ ~ ---
--- ----------.
GE\lERAL AGGREGtl,TE l's
-~-~~ ----
PRODuCTS (Ol/P/OP AGG S
1,000,00
07/01/2007
!I CO'o',8,NED SINGLE LIMIT S
~.~~CC'de~.'~__-t~--.!-!. 000, O()
: 800lL Y INJuRy $
I ',Per persor',1 I
180D~~~-'::RY ------~t--I -~---~
I 'Per aCCIClei)ij . $
t------------------- ----.+----.-~----~-------
I PROPUP'( [iM.I1AGE : $
,'Pei ace_denl)
!~uTO ONLr fA ACCIL;EJJT
I---~
: OTHER THAN EA A:::C e
! AUTO ONL Y A::;G I S ----~
07/01/2007 ,Er'CrlCCC'JRRtN~E S 6,000,00
kGGqEGA~t---~-=-=-~~QOO ,=00..
, I
t--=--===tf=---===
I $
06/30/2007 X 'ryc )'" ~ ~8T'~
f.- '--ilQF ~ llM ! S _ J:.B
~~~H 'cc="'- S ___~,iJQQ, 00_
I_E l CISEACE EA EMPLCJY [" I 1,000,00
07/01/20071~L 01~c6A-~~;;:'~~f'~~ Inc~d~~~'OO
I $6,000,000 Aggregate
I
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES' EXCLUSIONS ADDED By ENDORSE\t1ENT ,I SPECIAL PRO\iISIONS
he City of Coppell, its officials, employees, agents and officers shall be named an additional insured
(except workers compensation/employers liability) and shall be extended a waiver of subrogation on
11 coverages as required by written agreement.
CER TIFICA TE HOLDER CANCELLA TION
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEf, NOTICE TO THE CERTIFICATE HOLOER NAMED TO THE LEFT.
City of Coppell, Texas BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLlGATION OR LIABILITY
255 Parkway Boulevard OF A"Y ~IND UPON THE INSURER. IT5 AGENTS OR REPRESENT A TlVES
Coppell, TX 75019 AUTHORIZED REPRESENTATIVE 1J141LttJ~~
Mark Bush/LANE
ACORD 25 (2001/081
:0ACORD CORPORA TION 1988
IMPORT ANT
If the certificate holdec IS an ADDITIONAL 'NSURED the poiicy(les) must be enoorsed A staterr'ent
on this certlf'cate does not confer '1ghts to the cerclflcate holder 'n I,ee; of sucn enoorserT1ent(s)
r SUBROGATlor\! IS '/VAiVED. subjeCllo Ire te"'lS and condtlons Of Ihe OOley. certain policies may
reqUire a'1 endorsement A statei"ent or ,r,'s cer;If!;:::ale ooes not confer rlgr'5 to tne certificate
holder In lieu of SUCr1 endorsement si
DISCLAIMER
Trle Ce1,(lcate of Insurance on tre reverse Side of l.C,iS form does not constitute a corltract between
the Issuing r:lsurer(s). authorized represertatlve or producer. and the certificate holder nor does It
at:rmatlllely or negatively amend. extend or aiter the coverage afforded cy the poliCies listed thereon
ACORD 25 (2001/08)
City of Coppell, Texas
Certificate issued to City of Coppell, Texas
Meyers-Reynolds & Associates
OS/29,20C7
Excess Llabll,tl lncludes prem'ses, operatlCins, blo'M)ut or explOSlcn, prodGcts. completed opecatlons,
blanket cortratual llabl1ity, underground rescurces. broad form property damage, lndependent contractors
protect've llJb llty and personJ~ injury
03/29/2007