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POLICYHOLDER COPY NF <br /> STATECOMPENSATION P.O. BOX 8192, PLEASANTON, CA 94588 <br /> INSURANCE <br /> FUND <br /> CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 11-29-2019 GROUP: <br /> POLICY NUMBER: 9053901-2019 <br /> CERTIFICATE ID: 3 <br /> CERTIFICATE EXPIRES: 11-29-2020 <br /> 11-29-2019/11-29-2020 <br /> CONTRACTORS STATE LICENSE BOARD NF LIC PERMIT#: 954267 <br /> WORKERS COMPENSATION UNIT INCEPTION DATE: 11-29-2019 <br /> PO BOX 26000 DO:NF <br /> SACRAMENTO CA 95826-0026 <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 employer named below for the policy period indicated. <br /> This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. <br /> We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <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. <br /> Authorized Representative President and CEO <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> EMPLOYER <br /> GEO-EX SUBSURFACE EXPLORATION DBA: GEO - EX <br /> DRILLING <br /> 1510 MADERA DR <br /> DIXON CA 95620 <br /> M0409 <br /> (REv.7-2014) PRINTED 10-17-2019 <br />