|
ATE
<br /> ,alp o�® CERTIFICATE OF LIABILITY INSURANCE c10/28/2022D/YYYv)
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT Marsh Centralized Services
<br /> Marsh USA,Inc. NAME:
<br /> 1301 5th Avenue,Suite 1900 AIC NNo Ext: 866-966-4664 AIC No): 212-948-4326
<br /> Seattle,WA 98101 E-MAIL ADDRESS: Seattle.certrequest@marsh.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> CN109612360--GAUWP-22-23 999 N/A EX L1 INSURER A:Steadfast Insurance Company 26387
<br /> INSURED INSURER B:ACE American Insurance Company 22667
<br /> Cascade Drilling,L.P.
<br /> BU#999 INSURER C:ACE Fire Underwriters Insurance Company 20702
<br /> 22722 29th Drive SE,Ste 228 INSURER D:
<br /> Bothell,WA 98021
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: SEA-003795219-13 REVISION NUMBER: 6
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
<br /> LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY
<br /> A X COMMERCIAL GENERAL LIABILITY GPL9592232-00 11/01/2022 11/01/2023 EACH OCCURRENCE $ 2,000,000
<br /> DAMAGE TO CLAIMS-MADE � OCCUR PREMISES
<br /> ('a
<br /> a RENTED
<br /> ) $ 300,000
<br /> MED EXP(Any one person) $ 5,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> X POLICY❑ PRO-
<br /> POLICY ❑ LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> B AUTOMOBILE LIABILITY ISA H08869832 11/01/2022 11/01/2023 COEaMBINED accident SINGLE LIMIT $ 5,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS ONLY AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY Per accident
<br /> UMBRELLA LIAB X OCCUR SXS 9592234-00 11/01/2022 11/01/2023 EACH OCCURRENCE $ 5,000,000
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
<br /> X I DED X RETENTION$0 $
<br /> B WORKERS COMPENSATION WLRC68931800(AOS) 11/01/2022 11/01/2023 X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STATUTE ER
<br /> C Y/N SCFC68931812(WI) 11/0112022 11/01/2023 1,000,000
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? ❑N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under 1,000,000
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Pollution Liability GPL9592232-00 11/01/2022 11/01/2023 Each Poll Incident 2,000,000
<br /> A Professional Liability GPL9592232-00 11/01/2022 11/01/2023 Each Incident 2,000,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Evidence of Insurance ONLY
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Cascade Drilling,LP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> 22722 29th Drive,SE,Suite 228 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Bothell,WA 98021 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> AUTHORIZED REPRESENTATIVE
<br /> ?? "d 1rx¢Mae$erwiee¢
<br /> @ 1988-2016 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|