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POLICYHOLDER COPY NA STATE FUND P.O. BOX 8192, CERTIFICATE OF PLEASANTON, CA 94588 WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-19-2020 GROUP: POLICY NUMBER 9282808-2020 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 09-01-2021 09-01-2020/09-01-2021 CALIFORNIA DEPARTMENT OF MOTOR VEHICLES NA CAN: 0364410 MOTOR CARRIER PERMIT BRANCH INCEPTION DATE :09-01-2020 PO BOX 932370 DO:NA SACRAMENTO CA 94232-3700 This is to certify that we have issued a valid Workers Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #1651 - ANDREW PETER HERNANDEZ P - EXCLUDED. ENDORSEMENT #1651 - ZACHARY HERNANDEZ OTR - EXCLUDED. ENDORSEMENT N1651 - SIERRA RENEE HERNANDEZ S,T - EXCLUDED. 10-13-2020 IS EMPLOYER WEST COAST EXPLORATION, INC. (A CORP) NA PO BOX 133 ESCALON CA 95320 [P14,H01 (REV.7 -20141 PRINTED : 10-19-2020