Chesapeake-CS080303
ACDBQM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDlYYYV)
03/03/2008
PRODUCER (432)571-4900 FAX (432)682-3863 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Stoltz and Company, ltd. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3300 North A Street, Ste 1100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Midland, TX 79705
INSURERS AFFORDING COVERAGE NAIC#
INSURED Dawson Geophysical Company INSURER A: St. Paul Fire & Marine Ins Co
508 West Wall, Suite 800 INSURER B: Travelers Indemnity Company
Midland, TX 79701-5010 INSURER c:
INSURER D:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~': ~~I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P~~!9~Y EXPIRATION LIMITS
GENERAL LIABILITY VK04204074 01/01/2008 01/01/2009 EACH OCCURRENCE $ 1,000,00
I--
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,OO(J
I-- ~ CLAIMS MADE 00 OCCUR
MED EXP (Anyone person) $ 5 , OO(J
f--
A PERSONAL & ADV INJURY $ I,OOO,OO(J
I--
GENERAL AGGREGATE $ 2,OOO,OO(J
I--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00
IX1 POLICY n jr8;: n LOC
AUTOMOBILE LIABILITY VK04204074 01/01/2008 01/01/2009 COMBINED SINGLE LIMIT
~ ANY AUTO (Ea accident) $ I,OOO,OOC
I--
ALL OWNED AUTOS BODILY INJURY
f-- (Per person) $
SCHEDULED AUTOS
A I--
HIRED AUTOS BODILY INJURY
I-- (Per accidenl) $
NON-OWNED AUTOS
I--
I-- PROPERTY DAMAGE $
(Per accidenl)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY VK04204074 01/01/2008 01/01/2009 EACH OCCURRENCE $ 25,OOO,OO(]
m OCCUR D CLAIMS MADE AGGREGATE $ 25,OOO,OO(]
A $
~ DEDUCTIBLE $
X RETENTION $ 10,00( $
WORKERS COMPENSATION AND HHUB2161C36108 01/01/2008 01/01/2009 X I T"X~~T ~I#" I IOJ~-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT I,Ooo,OO(
B ANY PROPRIETORIPARTNERlEXECUTIVE $
OFFICER/MEMSER EXCLUDED? E.L. DISEASE - EA EMPLOYEI $ I,Ooo,OO(
~~~~I~s~~~V~S?~NS below E.L. DISEASE - POLICY LIMIT $ 1,000 00(
OTHER
~ESCRIPTlON OF OPERAn'f-S I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
E Job: lewisvi le Phase 1
~lanket waiver of subrogation on General liability, Auto li abi 1 ity , and Work Comp policies as required
py written contract with respects to work performed by the named insured (s). Blanket additional
~nsured on General liability and Auto liability as required by written contract with respects to work
!)erformed by the named insured (s) .
.._, nCD I &TlnN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of Coppell BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
255 Parkway Blvd OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Coppell, TX 75019 AUTHORIZED REPRESENTATIVE ~dtifr-
Mark A Stoltz/JRB
ACORD 25 (2001108)
@ACORDCORPORATION1981:
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)