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AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 6._ � 1 10/29/2018
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME:
<br /> Crystal&Company HONE 800-221-5830 ac Ne;800-383-1852
<br /> Crystal IBC LLC E-MAINo,L
<br /> 32 Old Slip ADDRESS:
<br /> New York NY 10005 INSURERS AFFORDING COVERAGE NAIL#
<br /> INSURER A:ACE American Insurance Co 22667
<br /> INSURED CASCDR INSURER B:ACE Fire Underwriters Insurance Company 20702
<br /> Cascade Drilling, LP
<br /> 22722 29th Drive SE, Suite 228 INSURER C:Allied World Assurance Company U.S. 1 19489
<br /> Bothell,WA 98021 INSURER D:Lloyd's of Landon
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:5017379 REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> ILTR TYPE OF INSURANCE ADDL SUER POLICPOLICY NUMBER MMIDP EFF POLICY MMIDDf EXP LIMITS
<br /> D X COMMERCIAL GENERAL LIABILITY ENVP000015018 11/1/2018 11/1/2019 EACH OCCURRENCE $1,000,000
<br /> 7�1_1 DAMAGE TO RENTED
<br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $300,000
<br /> MED EXP Any oneperson) $25,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000
<br /> X POLICY❑PRO JECT ❑LOC PRODUCTS-COMPIOP AGG $2,000,000
<br /> OTHER: Professional Liabill $1,000,000
<br /> A AUTOMOBILE LIABILITY ISAH25271956 11!1/2018 11/1/2019 COMBINED SINGLE LIMIT $5,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) $
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> $
<br /> D UMBRELLA LIAB X OCCUR ENVX000011718 11/1/2018 11/112019 EACH OCCURRENCE $5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED I I RETENTION$ $
<br /> A WORKERS COMPENSATION WLRC65434829 11/1/2018 11/1/2019 X PER OTH-
<br /> B AND EMPLOYERS'LIABILITY Y/N SCFC65434866 11!112018 11/1!2019 STATUTE ER
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/M EM BER EXCLUDE D7
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If es,describe under
<br /> DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> D Pollution Liability ENVP000015018 11/1/2018 11/1/2019 Each Poll Incident 1,000,000
<br /> C Excess Liability 03110034 11/1/2018 111112019 Excess Occurrence $10,000,000
<br /> Excess Aggregate $10,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required)
<br /> GENERAL LIABILITY: Additional Insured status when required by written contract(GAP1028 6/1/2016,GAP1004 6/1/2016);Additional Insured
<br /> Primary/Non-Contributory Amendatory when required by written contract(GAP1005 6/1/2016);Waiver of Subrogation when required by written contract
<br /> (GAP1030 6/1/2016).
<br /> AUTOMOBILE: Additional Insured status when required by written contract(DA91.174c 0316);Primary/Non-Contributory when required by written contract
<br /> (DA21886b 0614);Waiver of Subrogation when required by written contract(CA0444 1013)
<br /> WORKERS'COMPENSATION: Waiver of Subrogation when required by written contract-Other States(WC000313 1105);Waiver of Subrogation when
<br /> See Attached...
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ATC Group Services, LLC ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Attn: Kim Neep
<br /> 1117 Lone Palm Avenue,Suite 201B AUTHORIZED REPRESENTATIVE
<br /> Modesto, CA 95351 1, 9-
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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