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, 11i CERTIFICATE OF LIABILITY INSURANCE 01/02/2018 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 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 CONTACT NAME: AU Insurance Services PHONE (877)234-4420 FAX (877)234-4421 10825 Old Mill Rd (A/C,No,Ext): (A/C,No): E-MAIL Omaha, NE 68154 ADDRESS: PRODUCER (877)234-4420 CUSTOMER ID# INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURER A: California Insurance Co. 38868 were Brothers Well Drilling, Inc. INSURER B: dba Myers Brothers well Drilling, Inc. PO BOX 1283 INSURER C: Hanford, CA 93232-1283 INSURER D: INSURER E: CTL 1273 1412559 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/D MM/D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY ❑ ❑ DAMAGE TO RENTED CLAIMS PREMISES Ea occurrence) $ MADE 17 OCCUR MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 17 POLICY PROJECT171 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ❑ (Ea accident) $ ALLOWNEDAUTOS BODILY INJURY Perperson) $ SCHEDULED AUTOS BODILY INJURY Per accident $ HIRED AUTOS PROt�EdRnj DAMAGE $ NOWOWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE ❑ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ER Y TIMI AEANY PROPRIETOR/PARTNER/ XECUTIIVEOFFICER/MEMBER N/A 82-279230-01-02 01/01/2018 01/01/1019 E.L.EACH ACCIDENT $ 1,000, 000 EXCLUDED? 1,000, 000 (Mandatory In NH) E.L. ISEASE-EA EMPLOYEE $ If yes,describe under1,000,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY umrr $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach Acord 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Dbmrs Brothers Well Drilling, I=. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BCt}C X83 EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH PO THE POLICY PROVISIONS. Hanford, CA 93232-1283 AUTHORIZED REPRESENTATIVEr-^� Attn: Project Manager / 0 D 7 8 3 3 6 ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ©1988-2009 ACORD CORPORATION. All rights reserved.