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AGENCY CUSTOMER ID: CASCDR <br /> LOC#: <br /> AC R" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> —IIAGENCY NAMED INSURED <br /> Crystal&Company Cascade Drilling,LP <br /> 22722 29th Drive SE,Suite 228 <br /> POLICY NUMBER Bothell,WA 98021 <br /> CARRIER <br /> NAIC CODE <br /> EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br /> required by written contract-UT(WC430305 1000) <br /> All of the above is in accordance with the policy provisions and endorsements reflected. <br /> Additional Insured: <br /> Condor Earth <br /> 188 Frank West Circle Suite I <br /> Stockton,CA 95206 <br /> Raymond Investments <br /> 817 S.Center Street <br /> Stockton,CA 95206 <br /> Breit Stockton Industrial Park LLC <br /> PO Box#A3879 <br /> Chicago, IL 60690 <br /> The entities listed are included are included as Additional Insured and coverage is Primary/Non-Contributory when required by written contract in accordance <br /> with policy provisions and endorsements reflected for General Liability,Automobile Liability,and Excess Liability. Waiver of Subrogation when required by <br /> written contract in accordance with policy provisions and endorsements reflected for General Liability,Automobile Liability,Employers Liability,and Excess <br /> Liability. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />