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AGENCY CUSTOMER ID: CASCDR <br />LOC #: <br />ACCOR CP <br />8 <br />ADDITIONAL REMARKS SCHEDULE <br />Page i of <br />AGENCY <br />Crystal & Company <br />NAMED INSURED <br />Cascade Drilling, LP <br />22722 29th Drive SE; Suite 228 <br />Bothell, WA 98021 POLICY NUMBER <br />CARRIER NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />WORKERS COMPENSATION: Waiver of Subrogation when required by written contract-Other States (WC000313 1105); Waiver of Subrogation when required <br />by written contract-UT (WC430305 1000) <br />All of the above is in accordance with the policy provisions and endorsements reflected <br />Evidence of Insurance <br />ACORD 101 (2008/01) <br /> 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD