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YELLO-2 OP ID: DS <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE <br /> rATEMM/DDfYYYY) <br /> 03/30/2018 <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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Commercial Service Team <br /> Hill&Usher LLC NAME: <br /> Insurance. Bonds. Benefits. ac"N E •602-956-4220 A/c No: 602-956-4418 <br /> 3033 North 44th Street,#300S <br /> Phoenix,AZ 85018 SS,doccontrol@hillusher.com <br /> Steve R.Shields INSURERS AFFORDING COVERAGE NAIC III <br /> INSURER A:Travelers Property Casualty Co 25674 <br /> INSURED Yellow Jacket Drilling INSURER B:Travelers Property Casualty Co 25674 <br /> Services LLC <br /> Richard LeBlanc dba INSURER C:Travelers Indemnity Co 25658 <br /> Yellow Jacket Drilling INSURER D:Homeland Insurance Co of NY 34452 <br /> PO Box 801 <br /> Gilbert,AZ 85299-0801 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 SUB POLICY NUMBER MM/D DYYYY MPOLICY EFF MLICY EXP <br /> 1=wvp IDD <br /> ILIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> CLAIMS-MADE TOCCUR X X DT-CO-2J407688-PHX-18 04/01/2018 04/01/2019 DAMAGE TO RFNTFU- <br /> PREMISES Ea occurrence $ 300,00 <br /> MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,00 <br /> POLICY a PRO- <br /> JECT 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY Ea BIKED SINGLE LIMIT $ 1,000,00 <br /> B X ANY AUTO X X DT-810-2J354550-TIL-18 04/01/2018 04/01/2019 BODILY INJURY(Per person) $ <br /> ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> X AUTOS X AUTOS PROPERTY DAMAGE $ <br /> NON-OWNED Per acc dent <br /> HIREDAUTOS AUTOS <br /> $ <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00 <br /> B EXCESS LIAB CLAIMS-MADE UP-2J444660-17-26 04/01/2018 04/01/2019 AGGREGATE $ 10,000,00 <br /> DED I X I RETENTION$ 10000 $ <br /> WORKERS COMPENSATION XPER <br /> AND EMPLOYERS'LIABILITY STATUTE ER H <br /> YIN <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE X UB-2J440716-17-26 04/01/2018 04/01/2019 E.L.EACH ACCIDENT $ 1,000,00 <br /> OFFICER/MEMBER EXCLUDED? NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> B Equipment Floater 6601367M582 04/01/2018 04/01/2019 Insd equi as sched <br /> D POLL/PROF HA00003302018 04/01/2018 04/01/2019 Occ/Agg 10,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more apace Is required) <br /> RE: DRILLING SERVICES <br /> ADDITIONAL INSURED FORMS CGD46, OBENVGE301 & CAT353 ATTACHED. WAIVER OF <br /> SUBROGATION FORMS CGD316, OBENVGE319, CAT353 & WC000313 ATTACHED. <br /> CERTIFICATE HOLDER CANCELLATION <br /> GEOSYNT <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> GEOSYNTEC CONSULTANTS INC ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 10220 OLD COLUMBIA RD STE A <br /> COLOMBIA,MD 20146 AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />