Chesapeake-CS071101
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
11/1/2007
PRODUCER (918)493-1450, Fax(918)493-2395 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Meyers-Reynolds & Associates HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1425 E. 71st Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tulsa OK 74136 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Libertv Mutual
Chesapeake Operating Inc. INSURER B: AEGIS Limited . .,
POBox 18496 INSURERc:American Int' 1 Special tv
INSURER 0:
Oklahoma City OK 731540496 INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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.
A I A'n r.1 AIM!';
INSR ADD'L TYPE OF INSURANCE POLICY NUMBER P&.t+~~9&~88,w,E Pg~lfl(t~~JI,gN LIMITS
GENERAL LIABILITY SELF INSURED $ 1,000,000
- DAMAGE TO RENTED
COMMERCiAl GENERAl LIABILITY P I $
I CLAIMS MADE D OCCUR MED EXP IAnv one nerson) $
- P"R""NA' & AmI '''' " IDY $
- GENERAL AGGREGATE $
~'L AGGREnE LIMIT nES PER: PR"nll~T'" - $
POLICY ~kW;: LOC
~TOMOBILE LIABILITY AS1691522861037 07/01/2007 07/01/2008 COMBINED SINGLE LIMIT 1,000,000
$
~ ANY AUTO (Ea accident)
A ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
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~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
=SESSlUMBRELLA LIABILITY X0630AlA07 07/01/2007 07/01/2008 ,,^'"u $ 6,000,000
OCCUR ~ CLAIMS MADE AGGREGATE $ 6,000,000
$
B 8 DEDUCTIBLE $
X RFTENTION S 1. 000 000 S
A WORKERS COMPENSATION AND WAl69D522861067 06/30/2007 06/30/2008 Y I T~~Tf'JU<: I 10'!~-
EMPLOYERS' LIABILITY 1,000,000
ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000
II yes. describe under 1,000,000'
C:PEr-jAL PROVISION'" hAlow E.L. DISEASE - POLICY LIMIT $
C OTHER Pollution Liability PLC7554887 07/01/2005 07/01/2008 $6,000,000 Ea. :Incident
$6,000,000 Aggregate
DESCRIPTION OF OPERATlONSlLOCATlONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Coppell, its officials, employees, agents and officers shall be additional insured on all policies except
workers' compensation/emp~oyers liability) and shall be extended a waiver of subrogatio all coverages as required by
written contract.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Coppell, Texas EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
255 Parkway Boulevard ~ DAYS WRITTEN NOTICE TO THE CERTIACATE HOLDER NAMED TO THE LEFT, BUT
Coppall, TX 75019
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 71?~aJ~~-
Mark Bush/LANE
ACORD 25 (2001/08)
INS025 (0108).08a
@ ACORD CORPORATION 1988
Pagel 012
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an
endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such
endorsement( s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)
INS025 (0108).OSa
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