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. Ace/Rtf CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/19/2021 THIS CERTIFICATE CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh USA, Inc. 1301 5th Avenue, Suite 1900 Seattle, WA 98101 CN109612360--GAUWP-20-21 107 CONTACT Marsh Centralized Services NAME: PHONE 866-966-4664 FAX 212-948-4326 (A/C No Extl: (A/C. Not: E-MAIL ADDRESS: Seattle.certrequest@marsh.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Lloyd's Of London INSURED Cascade Drilling, L.P. BU #107 22722 29th Drive SE, Ste. 228 Bothell, WA 98021 INSURER B : ACE American Insurance Company 22667 INSURER C : ACE Fire Underwriters Insurance Company 20702 INSURER D' INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-003702931-01 REVISION N 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INS SUBR ,i II POLICY NUMBER POLICY EFF (MWDDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A ); COMMERCIAL GENERAL LIABILITY X X DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Hultgren - Tillis Engineers is included as additional insured where required by written contract with respect to general, auto, and pollution liability. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Hultgren - Tillis Engineers 4085 Nelson Ave. Suite A Concord, CA 94520-1257 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Michael Reggiani © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD