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DocuSign Envelope ID:5FA4B1AC-B897-4C32-A1E4-4B4A8885A341 <br /> CERTIFICATE OF INSURANCE Page 2 <br /> THE GRAY INSURANCE COMPANY <br /> The below coverages apply if the corresponding policy number is indicated on the previous page. <br /> A. Commercial General Liability <br /> General Liability Policy Includes: <br /> Blanket Waiver of Subrogation when required by written contract. <br /> Blanket Additional Insured (CGL Form# CG 20 10 11 86) when required by written contract. <br /> Primary Insurance Wording Included when required by written contract. <br /> Broad Form Property Damage Liability including Explosion, Collapse and Underground tXCU}, <br /> Premises/Operations <br /> Products/Completed Operations <br /> Contractual Liability <br /> Sudden and Accidental Pollution Liability <br /> Occurrence Form <br /> Personal injury <br /> "In Rem" Endorsement <br /> Cross Liability <br /> Severability of Interests Provision <br /> "Action Over" Claims <br /> Independent Contractors coverage for work sublet <br /> Vessel Liability- Watercraft exclusion has been modified by the vessels endorsement on scheduled <br /> equipment. <br /> General Aggregate applies per project or equivalent. <br /> B. Automobile Liability Policy Includes: <br /> Blanket Waiver of Subrogation when required by written contract. <br /> Blanket Additional Insured when required by written contract. <br /> C. Workers Compensation Policy Includes: <br /> Blanket Waiver of Subrogation when required by written contract. <br /> U.S. Longshoremen's and Harbor Workers Compensation Act Coverage <br /> Outer Continental Shelf Land Act <br /> Jones Act (including Transportation, Wages, Maintenance, and Cure), <br /> Death on the High Seas Act &General Maritime Law. <br /> Maritime Employers Liability Limit: $1,000:000 <br /> Voluntary Compensation Endorsement <br /> Other States Insurance <br /> Alternate Employer/Borrowed Servant Endorsement <br /> "In Rem" Endorsement <br /> Gulf of Mexico Territorial Extension <br /> D. Excess Liability Policy Includes: <br /> Coverage is excess of the Auto Liability, General Liability, Employers Liability, & Maritime Employers <br /> Liability policies <br /> Blanket Waiver of Subrogation when required by written contract. <br /> Blanket Additional Insured when required by written contract. <br /> Louisiana cerlfficale form: <br /> 101 CCI 280910 01 12 <br />