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lmr , CERTHOLDER 'SPY NK <br /> P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> CERTIFICATE OF WORKERS' COMPI,ENSATION INSURANCE <br /> ` ISSUE DATE: 10-01-2009 GRIOUP <br /> { 000713 <br /> POLICY NUMBER: 0020067-2009 <br /> CERTIFICATE ID: 213 <br /> CERTIFICATE EXPIRES: 10-01-2010 <br /> 10-01-2009/10-01-2010 <br /> GEOLOGICAL TECHNICS NK JOB:ALL CALIFORNIA OPERATIONS <br /> 1172 KANSAS AVE <br /> ! MODESTO CA 95351-1526 <br /> RECEIVED. SEP 2 42009 <br /> This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br /> California Insurance Commissioner to the.�empioyer named below for the policy period indicated. <br /> i <br /> This policy is not, subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> We will also give you 30 days advance notice should this policy be. cancelled prior to its normal expiration. <br /> i <br /> This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br /> by the policy listed herein. Notwithstanding any requirement- term or condition:of any contract or other document <br /> with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br /> afforded by the ,policy described herein is subject to all the terms, exclusions, and conditions, of such policy. I <br />! <br /> tTHORI�ZED REPRESENTATI PRESIDENT <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE.COSTS: $1,000,000 PER OCCURRENCE. <br /> ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2008-10-01 IS <br />{ ATTACHED TO AND FORMS A PART. OF THIS POLICY. NAME OF ADDITIbNAL INSURED: <br /> GEOLOGICAL TECHNICS I <br /> ENDORSEMENT #1600 - ROBERT E VICKERY, PRES EXCLUDED. <br /> i <br /> ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2008 IS <br /> ATTACHED TO;AND FORMS A PART OF THIS POLICY. <br /> i <br /> i <br /> i <br /> • i <br /> EMPLOYER F <br /> } <br /> � ,- V & W DRILLING, INC. NK <br /> 3806 DUCK CREEK DR <br /> STOCKTON CA 95215 <br /> M0408 <br /> -- IREv.2-051 PRINTED : 09-16-2009 <br /> I) R <br />