Chesapeake-CS090630
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A CORDm CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
6/30/2009
PRODUCER (405) 235-6633 FAX: (405) 235-6634 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Meyers-Reynolds & Associates Inc. ONLY AND CONFERS' NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1230 N. Robinson Ave AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Oklahoma City, OK 73103
n.wood@mrains.com INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Liberty Mutual Insurance 23043
Chesapeake Operating, Inc. INSURER B: AEGI S
P.O. Box 18496 INSURER C: American Int I 1 Group
Oklahoma City, OK 73154-0496 INSURER D: Colony Insurance Company 39993
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.
AG lREGATE L1MIT~ ~HOWN MAY HAVF RFEN REDIJr.FD BY PAID r.LAIM~.
I~~: ~~~~ TYPE OF INSURANCE POLICY NUMBER P6'.k+~~ri~~gg~~ P8~I~ll~~6~J.gN LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
f--- ~~~~~H?E~~~J~~ence)
X COMMERCIAL GENERAL LIABILITY $
D I CLAIMS MADE D OCCUR MED EXP (Anv one oerson) $
X Excess of Self AR64605l4 7/1/2009 7/1/2010 PER!;ONAL & ADV INJURY $
Insured $1,000,000 GENERAL AGGREGATE $
~'L AGGREnE LIMIT AAES PER: PRODUCTS - COMP/OP AGG $
POLICY ~~P.T LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- (Ea accident) $
X ANY AUTO
-
A ALL OWNED AUTOS ASl-691-522861-039 7/1/2009 7/1/2010 BODILY INJURY
- (Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
-
D X Excess of $1,000,000 AR6460514 7/1/2009 7/1/2010 PROPERTY DAMAGE
- (Per accident) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
l ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH $ 6,000,000
::=J OCCUR D CLAIMS MADE AGGREGATE $ 6,000,000
- $
B l DEDUCTIBLE X0630A1A09 7/1/2009 7/1/2010 $
RETENTION $ $
A WORKERS COMPENSATION AND X I ~~.n~JI~S I OJ~-
EMPLOYERS' LIABILITY 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? WAl-69D-522861-069 7/1/2009 7/1/2010 E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under 1,000,000
SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $
OTHER
C Pollution Liability PLC24206803 7/1/2009 7/1/2010 Each Incident $6,000,000
Aqqreqate $6,000,000
DESCRIPTlON OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Coppel1, its officials, employees, agents and officers is listed as an additional insured per form
#CA20480299 under policy #ASl-69l-52286l-039. An example endorsement is available from the company upon request. The
insurance company waives any right of subrogation against The City of Coppell, its officials, employees, agents and
officers which may arise by reason of payment under policy #ASl-69l-522861-039, Policy #WAl-69D-522861-069, Policy
#AR6460514 , Policy #PLC24206803 & Policy # X0630A1A09. Certificate Holder is also Additional Insured regarding Excess
CERTlFICA TE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Coppe11, Texas EXPIRATlON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
255 Parkway Blvd. 30 DAYS WRITTEN NOTlCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Coppe11, TX 75019 -
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 7n~a.J/~
Mark Bush/MANDY
ACORD 25 (2001/08)
INS025 (0108).08a
@ACORD CORPORATION 1988
Page 1 of 2
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).08a
Page 2 of2
COMMENTS/REMARKS
coverage and Pollution Liability as required by written contract.
OFREMARK
COPYRIGHT 2000, AMS SERVICES INC.