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DATE (MMIODIYYYY) <br /> ACURV CERTIFICATE OF LIABILITY INSURANCE s11912o1a <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO TS UPON THE CERTIFICATE HOLDER. THIS <br /> THE <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 <br /> WAiVED subjectrIto the;11 1DDimlOand conditions h P)ollcy, certain Policiesmust havie Dmayy requi11 ,10 re an enndorsemSUREDpr ient A statement n <br /> if SUBROGATION <br /> this certificate does not confer rights to the certificate holder In lieu of such <br /> ronT dorsement(s). <br /> PRODUCER <br /> NAME* CT Deidre Hagen rA <br /> InterWest Insurance Serv. , LLC PHONE b30 897-3180 ! ( ars_ a uo)- 530 891 -77E0 <br /> tEBLGANExBL( -� <br /> License #OB01094 ADOREss: . je�Giwlns.com -- <br /> P.O. Box 8110 r MAIC e_ <br /> Chico CA 95927-8110 INSURER AFFORDING COVERAGE 24856 m <br /> INSURERA Admiral insurance Company..___-._.__—._.L._.-•- <br /> 24066 <br /> MVPPE-i INSURER B American Fire & Casualty CD - _ 39993 _ <br /> INSURED <br /> MVP Petroleum Engineering , Inc INSURERC . ril insurance company ..---- 35076 <br /> PO Box 281 INSURERD State Comp Ins Fund (CA) <br /> Folsom CA 9576311110281 INSURERe <br /> INSURER F : '.. <br /> COVERAGES CERTIFICATE NUMBER: 609396546 <br /> REVISION NUMBER: <br /> HAVHIS IS TO CNOT111 NOTWITHSTANDING THE POLINY CIES <br /> OF INSURANCE <br /> SURAN TERM OR CONDITION E ANY CON EEN OR OTHER DOCUMENT WITH RED TOT I SURED NAMED ABOVE OSPECT TO R THE WHICH PERIOD <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU THE TERMS- - <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED <br /> , EFF PAPou Y EXP LIMITS <br /> iNS R A� S 'r" R POLICY NUMBER _ <br /> LTR TYPE OF INSURANCE 9/1801 & 91112019 EACHOCCURRENCE 51 ,000000 <br /> A X COMNERCIALGENERALLIABILITY FEIECC1732DOS _ <br /> (� I PREMISES tEa aaurencet S50,000 <br /> I CLAIMS AU OE L�t OCCUR l MED EXP (Arty one parsa�) <br /> 111 PERSONAL & ADV INJURY ( S Loon 000__�.�___— <br /> GENERAL AGGREGATE ( 52.000.000 <br /> 99 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS . COMP/OPAGGIS ?,000.000 <br /> POLICY Q eaf Q LOC ( S <br /> , <br /> OTHER: I COldBINED'SMfG!:EliidiT ( : t ,000.d;0 <br /> eAASS800404 712DI2017 11202018 a aeoden0 ' —.- . <br /> B AVTOMOSILEr-IABUTY BODIIYiNJVRY (Pl S <br /> t X ANY AUTO BODILY INJURY (Per accident) $ <br /> OWNEDSCHEDULED PROFEti'rYOAMAG£ S <br /> 111 AUTOS ONLY P <br /> AUTOS I pQr as c!eI'HIRED NON-OWNEDAUTOS ONLYAUTOS ONLY I <br /> C UMBRELLA LIAB X OCCUR EX04223164 <br /> 9f148010 DAf2019 EACHOCCURRENCE9000 <br /> Ic ,000 <br /> 1 � AGGREGATE <br /> X EXCESS UAB CLAIMS-MADE } Nil I <br /> i S <br /> OE0 1 RETENTIONS 1 0 H <br /> 10118010 ( 10112079 (X PETt <br /> 0 WORK ERSCOMPENSATION <br /> 907307518 �57ATUTE _—�3 —_..;. . . _. _ .. <br /> AND EMPLOYERS' LIABILITY Y.f N . T E.L. EACH ACCIDENT I S 7 .000.000 <br /> ANYPROPRIE oRIPARTNER1EXE10"VE y N f A ` E.L. DISI EASE ' EA EMPLOYEE_5 <br /> (Mondatoryl in NH)BER CLUDE07 t-- <br /> ( yan atonydoscin ands! ! i i E.L. DISEASE - POLICY LIMIT ( 5 ODO.= <br /> 10ESCRIPTION OF OPERATIONS.hebw <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached If more apaco Is required) <br /> Confirmation of Coverage. <br /> CANCELLATION <br /> CEFMFICATE . HOLOFJi <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,ACCORDANCE WITH THE POLICY <br /> PROVISIONS.E WILL BE DELIVERED IN <br /> MVP Petroleum Engineering , Inc AUTHORMEDREPRESENTAl <br /> PO Box 261 { <br /> Folsom GA 95763 /7 <br /> 1 ( D 1tilililif <br /> 988.2015 ACORD CORPORATION . All rights reserved . <br /> The ACORD name and logo are registered marks of ACORD <br /> ACORD 25 (2016103) <br /> E <br /> I <br />