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7 t� DATE (MMIDD/YYYY) ACC I?V CERTIFICATE OF LIABILITY INSURANCE 9/19/2018 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( les) must have ADDITIONAL INSURED provisions or 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 con+4 9OT S1ADeidre Hagen —r =_ —y _-- -- InterWest Insurance Serv. , LLC PHONE 630 897-3180 iac, No);. j53f� 891 7780 . . ,.___ _ _. License #OB01094 MAit. Xl)'L) P. O . Box 8110 AooREss : dhagen@iwins. com ...... Chico CA 95927-81 10 _ INSURERS AFFORDING COVERAGE NAIC iF_�__._ .. .__ . .. . . ...._._._-- -___.._ ._. ..___. _.. _.._._ _._._ _INSURER_A: Admiral Insurance Company __ _ __..__ ..__ . _ ___ _ _ _ . _._ _ 24856 INSURED MVPPE-1 INSURER B : American Fire & Casualty CO 24066 MVP Petroleum Engineering , Inc PO Box 281 iNsuRERc__Colony Insurance_Compan_y. . _ _ __.__.. . ... .- . 3993 — Folsom CA 95763-0281 !NsURERD : State Comp INSURER E : _- INSURER r : COVERAGES CERTIFICATE NUMBER : 809396546 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 - _. .- TYPE OF INSURANCE ......._._w ADo LISG$Rl '. " _ POLICY NUMBER POLICY EFF MMIODlYYYY LIMITS LTR I A X Cc MERCIAL GENERAL LIABILITY FEIECC1732905 911 /2016 91112019 EACHOCCURRENCF. S1 ,Onn,ano 1 i 6FtaAZ3E�iT3t�7Eb -- — – _ I CLAIMS-MADE f(� X OCCUR I P£2EiiSE$ ( 9 artt;r once) — $ 50 ooa ... .. } MED EXP (Any one parson) S 5,000 PERSONAL & ADV INJURY _$ 1 ,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: _ GENERAL AGGREGATE $ 2,000,000 POLICY 0 PROs E} LOC PRODUCTS - COMP/OPAGG 52000.000 OTHFR: $ B AUTOMOBILE LIABILITY BAA56800404 1120/2017 11202COldaiNED-SINGLE LIMIT 016 $ 1 ,0G0,000 X ANY AUTO BODILY INJURY (Per person) S —_ ` OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS ONLY AUTOS HIRED NOWOWNED hROFERTYDAI.tAGF S �. AUTOS ONLY ,.,. AUTOS ONLY _(per accident).__._......_._..._...-_—.- _�_......__._...._.......__......_._......_...__ i C UMBRELLA LIABX OCCUR EX04223164 91142018 911/2019 EACH OCCURRENCE $ 9,000,000 X EXCESS LIAR CLAIMS-MADE - AGGREGATE $ DEO RETENTION $ p WORKERS COMPENSATION 907307518 10712016 I 10/12019 ;X 81E ATUTE„ OERIj AND EMPLOYERS' LIABILITYI ! ANYPROPRIETORIPARTNER/EXECUTIVE YI N i E.L. EACH ACCIDENT $ 1 000 000 OFFICERIMEMBER EXCLUDED? NIA I (Mandatory in NH) E.L.. DISEASE - EA EMPLOYEEI $ 1 .000.000 If yes, desuibo under ) r .L, DISEASE - POLICY LIMIT I $ 1,000.000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101 , Addltionai Remarks Schedule, may ba attached If more apace la required) - -- Confirmation of Coverage. ' � - f 1 � CERTIFICATE HOLDER 11 CANCELLATION " M lE N 5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS . MVP Petroleum Engineering , Inc PO Box 281 AUTHORIZED REPRESENTATIVE Folsom CA 95763 cL © 1988-2015 ACORD CORPORATION , All rights reserved . ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD e