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.TUU 2%'90 11:33 LIBER' SLC —SM111 _ P.2 <br /> Certificate of IneurAnce <br /> TRIS CERrIMOATE 19 ISSUED A9 A MATTER OF INFORMATION ONLY AND CONFERS NO AQHTS UPON YOU THE CERTIF4CATE HOLLER,THIS CERTSFICATE IS NOT AN INSURANCE <br /> POLICY AND DOEd NOT AhtI:ND,ExT@ND,GR ALTER THE COVERAgE AFFORDED 11--'HE POL;CIEa LIBTBD BELOW. <br /> This Is to Certify that LIBERTY <br /> F --� 1�I1�,J .L LJt�L <br /> Tonto Drilling Services, Inc./Pioneer Drilling 11 <br /> � Nttrn9 address o <br /> 2200 South 4000 West Ineureof <br /> Salt Lake City, UT 84125 Insured. <br /> Is,at the"vii gets of this cenliteats,Insured by Me Company under the pofty)Ies)listedb low.The insurance altorded by the listed palicy(esJ is subject to all their <br /> tarme,excluelons and conditions and is not pherad by any requlrament,term or conMbon of any contract or*Mer document with raapact to which this cenlflcau may <br /> be Issued. <br /> TYPE CSRT. EXP. DATE• LIMIT <br /> OF DCONTINUOUS POLICY OF LIABILITY <br /> POLICY ❑CXTeNDEO NUMBER <br /> LICY TERM <br /> COVERAGE AFFOflDED UNDER W.G. EMPLOYEia'9 LfA91uTY <br /> LAW OF THE FOLLOWIN(A STATES: 500y In u $I Acaldenl <br /> 4/x./91 wc2-1S1-033012-02 CA 1, %'000 <br /> WORKERS' <br /> BadaY injury By Olseaea <br /> 1,000,000 <br /> p t.I_Imlt <br /> COMPENSATION l;odhy InJury fay Dleeese <br /> 1,000,000 <br /> Ea.Parson <br /> Gomel Aggregate•Omer inan FrgductelCempleteU Cperatlone <br /> ProouctelComplated Operation-Aggmgate <br /> gogity Injury and Ptoperty Damage Liability <br /> per occurrence <br /> Q CLAIMS MADE Pareonel and Advenleing injury <br /> m per <br /> neparad7nl <br /> DATE wganlzatton <br /> thei <br /> d OCCURRENCE <br /> GFUCIALIEXCL, <br /> ENDORSEMENTS <br /> El OWNED EACH ACCIDENT•MNGI.E LIMIT•B.l,AND RD.COMBINED <br /> Z)WON-OWNED EACH PERSON <br /> _ EACH ACCIDENT EACH ACCIDENT <br /> 13 HIRED OR OCCURRENCE $ OR OCCURRENCE <br /> W All States Endorsement <br /> Voluntary Compensation <br /> LOCATION(B)aF OPERATIONS&JOB d(it Applicable) ^ DESCRIPTION Or OPERATIONS; <br /> RTS: <br /> "H the ardflcate axplratlor date is conisnuous or exiandad tsrm,^you wili be nodflad it co�is terminated or reduoad before the certificate expiration date, However, <br /> you wul riot be notified ennua!ly or Itte continuation of coverage. <br /> NOTICE OF CANCELLATION; THE COMPANY WILL NOT TERMINATE O� Insu <br /> �EDUCE rty Mutual <br /> nsurlettte Group <br /> THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNLESS--DAYS <br /> NOTICE OF SUCH TERMINATION OR RIEDUCTION HAS BEEN MAILED YO; <br /> F <br /> I <br /> Public Health Services <br /> CERTIFICATE San Joaquin County <br /> HOLDIER P.O. BOX 2009 <br /> WOflIZED EPRESENTATIVE <br /> 1601 Hazelton <br /> L Stockton, CA 95201 � June 2 , 19 0 SLC, UT <br /> DATE ISSUED OFFICE <br />