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AC" CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYYY)
<br /> 8/23/2017
<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
<br /> CONT
<br /> NAME: M 13Drla _
<br /> JILT Specialty USA IA Ext)A15-930-9046
<br /> PHONE AIC No
<br /> 135 Main Street E-MAIL
<br /> Suite 1600 A DREss:donna.boCeaOiltus.com
<br /> San Francisco CA 94105 INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A Axis Surplus Insurance Company
<br /> INSURED GREGDRI-01 INSURER B• n Insurance man 16535
<br /> Gregg Drilling &Testing, Inc. INSURERC:
<br /> 2726 Walnut Avenue INSURER D:
<br /> Signal Hill CA 90755
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:747528704 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 /> INSR TYPE OF INSURANCE D POLICY EFF POLICY EXP
<br /> LTR INR POLICY NUMBER MM/DDIWYY MM/DDIYYYY LIMITS
<br /> A GENERAL LIABILITY SP002682-01-2017 8/1/2017 8/1/2018 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED—
<br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000
<br /> CLAIMS-MADE IR-1 OCCUR MED EXP(Any one person) $25,000
<br /> PERSONAL&ADV INJURY $1,000,000
<br /> GENERAL AGGREGATE $2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
<br /> POLICY X I PRO- LOC $
<br /> B AUTOMOBILE LIABILITY BAP0235382-00 8/1/2017 8/1!2018Ea accident $1,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> X HIRED AUTOS X AUTOS Per accident
<br /> $
<br /> A X UMBRELLA LIAB X OCCUR SX002683-01-2017 8/1/2017 8/1/2018 EACH OCCURRENCE $4,000,000
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
<br /> DED RETENTION$ $
<br /> B WORKERS COMPENSATION WCO235381-00 8/1/2017 8/1/2018 X WC STATU- OTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000
<br /> OFFICER/MEMBER EXCLUDED? Y� N/A
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> A Contractors Pollution Liability SP002682-01-2017 8/1/2017 8/1/2018 each claim $1,000,000
<br /> Professional Liability each claim $1,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
<br /> Geosyntec Consultants is an additional insured on the General,Automobile and Excess Liability policies where required by written contract or
<br /> agreement subject to policy terms, conditions and exclusions. Professional Liability is claims made. Per Project General Aggregate excludes
<br /> Professional Liability. Umbrella is excess over General Liability, Pollution and Professional Liability,Automobile and Employer's Liability
<br /> coverages.Waiver of subrogation applies in favor of the certificate holder on the General,Automobile,Workers Compensation and Excess
<br /> Liability policies where required by written contract or agreement.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Geosyntec Consultants THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 2100 Main St., Suite 150 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Huntington Beach CA 92648
<br /> AUTHORIZED REPRESENTATIVE
<br /> ii
<br /> ©1988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
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