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<br /> ,aCCOR oma® CERTIFICATE OF LIABILITY INSURANCE c10/28/2021DIYYYv)
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Marsh Centralized Services
<br /> NAME:
<br /> Marsh USA,Inc.
<br /> 1301 5th Avenue,Suite 1900 AIC NNo Ext): 866-966-4664 A : 212-948-4326
<br /> /C No
<br /> Seattle,WA 98101 E-MAIL
<br /> ADDRESS: Seattle.certrequest@marsh.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> CN109612360--GAUWP-21-22 109 EX L1 INSURER A:Lloyd's Of London
<br /> INSURED Cascade Drilling,L.P. INSURER B:ACE American Insurance Company 22667
<br /> BU#109 INSURER C:ACE Fire Underwriters Insurance Company 20702
<br /> 22722 29th Drive SE,Ste.228 INSURER D:
<br /> Bothell,WA 98021
<br /> INSURER E,
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: SEA-003741798-02 REVISION NUMBER: 2
<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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> A X COMMERCIAL GENERAL LIABILITY X X ENVP000015021 11/01/2021 11/01/2022
<br /> EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO CLAIMS-MADE � OCCUR PREMISES
<br /> a RENTED
<br /> $ 300,000
<br /> MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> X POLICY❑ PRO-
<br /> POLICY ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY X X ISA H08875625 11/01/2021 11/01/2022 COEaMBINED accident SINGLE LIMIT $ 5,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> UMBRELLA LIAB X OCCUR X ENVX000011721 11/01/2021 11/01/2022 EACH OCCURRENCE $ 5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> X I DED X RETENTION$0 $
<br /> B WORKERS COMPENSATION X WLRC68930856(AOS) 11/01/2021 11/01/2022X PER OT
<br /> H-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> 1,000,000
<br /> C YIN SCFC68930868( )WI 11/0112021 11/01/2022 E.L.EACH ACCIDENT $
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE
<br /> OFFICER/MEMBER EXCLUDED? ❑N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Pollution Liability ENVP000015021 11/01/2021 11/01/2022 Each Poll Incident 1,000,000
<br /> A Professional Liability ENVP000015021 11/01/2021 11/01/2022 Each Incident 1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Arcadis is included as additional insured where required by written contract with respect to general,auto,and pollution liability. Contractual Liability is included in General Liability subject to policy terms and
<br /> conditions. The above General Liability policy contains a Severability of Interest clause. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations
<br /> 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.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Arcadis SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> Attn:Audrey Naylor THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> 101 Creekside Ridge Ct.,Suite 200 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Roseville,CA 95678
<br /> AUTHORIZED REPRESENTATIVE
<br /> 2L.Srg 49",
<br /> @ 1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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