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GULFS-1 ACORN DATE(MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 09/23/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. 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). PRODUCER 530-622-9300 c ADT Kathleen Verplancken Capital Sierra Ins.Svc.LLC. PHONE 530-622-9300 FAX 530-622-9303 694 Pleasant Valley Road#7 A/C,No,Still: (A1C,No): Diamond Springs,CA 95619 E-MAIL — Kathleen Verplancken DRE35• INSURER(S)AFFORDING COVERAGE INSURER A:Allstate Insurance Company INSURED INSURER B:TOPA Insurance CO Gulf Shore Construction Svc Inc.dba G S Exploration INSURER C,State Compensation Ins.Fund 35076 PO Box501 Shingle 1prings,CA 95682 INSURER D: ISURERE: _ NISURER F COVERAGES CERTIFICATE BREVISION THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL SUB POLICY EFF POLICY EXP WV POLICY NUMBER LIMITS COMMERCIAL GENERAL LIABILITY ---- EACH 0 URRENCE CLAIMS-MADE [ -]OCCUR DAMAGE TO RENTED PREMISESJFa -- --- ---- MED EXPSAny one person _ --- - PERSONAL&ADV INJURY GEN.L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE F1'ofPOLICY I�LOC PRODUCTS-COMPIOP AGO S OTHER. A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 11000,000 X ANY AUTO X X 648836933 12/12/2018 12/12/2019 BODILY INJURY Perperson) OWNED SCHEDULED — AURTEOpS ONLY AUTOSBODILYBRORDILY INJURY(Per accident X AUTOS ONLY X AUTO ONLY Pe1acadenl AMAGE ---- - --- B UMBRELLA LIAR X OCCUR EACII OCCURRENCE _ _ 1,000,000 X EXCESS LIAO CLAIMS-MADE XL0020021002 02/10/2019 12/12/2019 AGGREGATE $ 1,000,000 ENTION$ DED RET C WORKERS COMPENSATION PER OTII AND EMPLOYERS'LIABILITY X LLEL ANY PROPRIETORIPARTNERIEXECUTIVE YIN X 9066678-19 08/02/2019 08/0212020 E.L.FACH ACCIDENT $ 1,000,000 OFFICER EXCLUDED? NIA 1,000,000 (Mandatory n NN) F.L.DISEASE-EA EMPLOYEE $ I I yos,d,,,j'under - — DF C 1 TION OF OP ONS alp E-POLICY LIMIT 1,000,000 I -- T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more Space is required) Crawford&Associates,Inc.is named as an additional insured as respects commercial auto insurance policy form AACW20101. Additional Insured status is provided on a blanket basis and is triggered by written contract.All California Projects, Revised. CERTIFICATE LDE CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Crawford&Associates,Inc ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Corporate Way,Ste 230 Sacramento,CA 95831 AUTHORIZ D REPRESEMATIVE KtI6nVer I n ACORD 25(2016103) ©1988-2016 ORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD