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0 DATE(MMIDD/YYYY) AC CORD CERTIFICATE OF LIABILITY INSURANCE 9/19/2012 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 ‘Iir. REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 NAMEACT Kathy Jackson HUB International Rigg PHONE FAX 777 Main Street, Suite C50 (A/C,No,Ext): (817) 820-8100 (AJC,No):(817) 870-0310 E-MAIL ADDRESS: keithy.jackeonQhubinternational.cofn Fort Worth TX 76102 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Burlington Insurance Group 50504 INSURED 14041 959-2507 INSURER B:CODA ree & Industry Insurance Co 19410 Iron Sky, Inc. INSURER C: 1773 Westborough Drive INSURERD: Katy TX 77449 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: Cert ID 39554 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. ADDL SUBR POLICY EFF POLICY EXP ILTSR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYYI (MMIDD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE10 HEN I ED A X COMMERCIAL GENERAL LIABILITY HGL0030754 4/3/2012 4/3/2013 PREMISES(Ea ccurrence) $ 50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY Xei n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) A ANY AUTO HGL0030754 4/3/2012 4/3/2013 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS $ B X UMBRELLALIAB X OCCUR BE020437593 4/3/2012 4/3/2013 EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- ()TH- ANE)EMPLOYERS'LIABILITY Y!N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ lI yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 8 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ********For Bid Purposes Only******** AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Page 1 of 1