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1 DATE(MM(DD)YYYY) <br /> A�RU CERTIFICATE OF LIABILITY INSURANCE <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 poiicy(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 endorsements. <br /> PRODUCER NAME: (inl(IGi WS <br /> Nato I inanci;d,Inc.Insurance and Financial Solutions IA/t.No Ettt <br /> (559 733-?1R`> A+C,No). 30 <br /> F-MAW <br /> ?D-15 South Court Street.Suite A ADDRESS: erns:ena�t�iinaneial corn <br /> INSURERS)AFFORDING COVERAGE NAIC# <br /> A 0327 INSURERA: SIAIF CO,NII'I NSA110\ INS I IINO U?( <br /> INSURED INSURER B T <br /> A( ju DI'111i11L D6:\W'aici Well Drilling INSURER C <br /> 1010 UST INSURER D: _ <br /> INSURER E <br /> \41 RC11T C:1 ,51-0-57a-' INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY T"HAT 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 /> CXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> I.TR TYPE OF INSURANCE INgp yyyp POLICY NUMBER (MMIDD/YYYY, (MMfDD/YYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> CLAIMS-MADE ❑OCCUR PREMISES(Ea oa:unenw) <br /> MED EXP(Any One person) 5 <br /> PERSONAL A ADV INJURY > <br /> P;E N•L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S <br /> POLICY <br /> ❑PRO-JEC ❑LOC PRODUCTS-COMP OP AGG S <br /> T 5 <br /> HOTHER <br /> AUTOMOBILE LIABILITY (Ea accident <br /> ANY AUTO BODILY INJURY(Pnr person) S <br /> OAP/NED SCHEDULED BODILY INJURY(Per accident) S <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED ' MAUE S <br /> (Per aiat!anl) <br /> AUTOS ONLY AUTOS ONLY <br /> 5 <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DEU I i RETENTIONS <br /> WORKERS COMPENSATION S'TA.TUTE ER <br /> AND EMPLOYERS'LIABILITY Y I N <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S I•O(111•(NI(1 <br /> A 7FFIi:EPMEMBEREXCLUDED? a NIA 935GS;0 p3j]31202d (li/?}2/21125 <br /> (Mandatory in NH) E.L.DISEASE-LA EMPLOY <br /> 5 )-O(IO.11(1(1 <br /> t yes.describe,under T I,(IU(6000 <br /> )ESCRIPTION OF OPERATIONS bOIOw E.L.DISEASE_-POLICY LIMA. 5 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached A more space is required) <br /> i'raof of In,urar,rr <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL.BE DELIVERED IN <br /> A Caja Drilling DBA Water Well Drillint ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1010 L ST AUTHORIZED REPRESENTATIVE <br /> Chantal Navo <br /> n4F:RCED CA 95341 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />