P4000028001
American International Group, Inc.
PO Box 25565
Shawnee Mission, KS 66225
202205020200
Electronic Service Requested
1'OF 1
78 0.0118 Check No.: 11017340
RFP No.: 583032 ENV 78
Check Date: 04/30/2022
SHE FOURTH ARE BED A
ATTN JANICE GALLEHER Check Amount: 1,015,924.40
CHULA VISTA- CA 91910-2631 Insured: CSAC EXCESS INSURANCE AUT Claimant: CSAC EIA CITY OF CHULA VISTA
Claim Office: 501
Insuring Company: LEXINGTON INSURANCE
COMPANY
Payee Name: City of Chula Vista
Reference No. 00548479
Policy No. Claim No. Symbol Date of Loss Type Status Amount 000025860222 7609166959US 001 02/01/2018 IND 1,015,924.40 Total Amount 1,015,924.40
Reason for Payment
Partial payment per statement of loss
Use File # 7609166959US on all correspondence for prompt processing.
For check information call: 877-802-5246
646586 (PC6)
FOR SECURITY PURPOSES, THE FACE OF THIS DOCUMENT CONTAINS A BLUE BACKGROUND AND MICROPRINTING IN THE BORDER LEXINGTON INSURANCE COMPANY 50:935/213
Claim No: 7609166959US Policy No.: 000025860222 CHECK No. 11017340 Reason for Payment Partial payment per statement of loss RFP No. 00583832 DATE :04/30/2022
*One Million Fifteen Thousand Nine Hundred Twenty Four & 40/100 Dollars*** AMOUNT PAID *******$1,015,924.40
Void after 90 Days
PAY City of Chula Vista
TO THE
ORDER OF ›
Sake turtle
JPMORGAN CHASE BANK, N.A.
SYRACUSE. NY 13206
DO NOT CASH IF SECURITY SCREEN IS NOT PRESENT ON THE REVERSE SIDE OF THIS DOCUMENT. 1 1101734 0213093790 7864205620°