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TSADRIL-01 TGALART '4�oRo CERTIFICATE OF LIABILITY INSURANCE DAT8/4/2 DIYYYY) 8/4/2021 THIS 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 License#OB50501 CONTACT Teresa Galart NAME: Armstrong&Associates Insurance Services PHONE,Ext):(530)406-2742 242 FAX C,No):(530)668-2779 239 W Court St,Bldg A Woodland,CA 95695 ADDRIESS:tgalart@armstrongprofesslonaI.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Homeland Insurance Company of New York 34452 INSURED INSURER B:West American Insurance Company 44393 TSA Drilling Inc. INSURERC:State Compensation Insurance Fund 35076 PeneCore Drilling 220 North East St INSURER D:Ohio Security Insurance Company 24082 Woodland,CA 95776 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS TR IN D WV I IYYYY MM A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR7930113350000 8/5/2021 8/5/2022 DAMAGE TO RENTED 100,000 X X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X E LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY (Ea accident) _$ X ANY AUTO BAW56829954 8/5/2021 8/5/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY AUUTOS ONLYY PROPERTY DAMAGE $ Per accident A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000 X EXCESS LIAB CLAIMS-MADE 7930113360000 8/5/2021 6/5/2022 AGGREGATE $ 9,000,000 DED RETENTION$ $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X 928116321 8/1/2021 8/1/2022 E.L.EACH ACCIDENT $ 1,000'000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1'000'000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Property BKS56829954 8/5/2021 8/5/2022 Building 481,500 D Equipment Floater BKS56829954 8/5/2021 8/5/2022 Rented Leased Borrow 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Geosyntec Consultants,Inc.and Geosyntec Consultants International,Inc. and client are named additional insured per attached endorsement. Waiver of Subrogation attached for the General Liability. Waiver of Subrogation for the Work Comp attached. RE: All Operations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Geosyntec Consultants,Inc.and THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Geosyntec Consultants International,Inc. 900 Broken Sound Parkway,Suite 200 Boca Raton,FL 33487-2775 AUTHORIZED REPRESENTATIVE G� ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD