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R e ui strati nn e <br />DocuSign Envelope ID: 01 C1 DA1 D-6C6A-4608-A484-D928555169F0 <br />Page 1 of 2 <br />f State of California <br />F <br />A. <br />Department of Industrial Relations <br />(https:/ .ti r.ca.gov/ <br />Contractor Information <br />Legal Entity Name OV ERL4NU VACIFIC & CUTLER_ LLC <br />_orpomPon <br />Active <br />IOODUL4746 <br />07/U1120 <br />06/3W21 <br />375U SCHAUFELE AVE, SUITE 150 LONG BEACH 908US CA United States of America <br />3750 SCHAUFELE AVE, SUITE 150 LONG BEACH 90808 CA United States of America <br />ontmc6Lm opcservices.rom <br />License Number (s) <br />Legal Entity Information <br />Corporation Entity Number: <br />Federal Employment Identitication Number: <br />President Name: <br />Vice President Name: <br />Treasurer Name: <br />Secretary Name: <br />CEO Name: <br />Agency for Service: <br />Agent of Service Name: <br />Agent of Service Mailing Address: <br />Worker's Compensation <br />201726810156 <br />953559948 <br />BRIAN EVERETT <br />MARKLABONTE <br />LED <br />RAY ARMSTRONG <br />BRIAN EVERETT <br />Back to DIR» (https:/Avww.dir.ca.goi <br />MARK LA BONTE <br />3750 SCHAUFELE AVE, SUITE 150 LONG BEACH 90809 CA United States of America <br />Do you lease employees through Professional Employer Organization (PEO)?: No <br />Please provide your current worker's compensation insurance information below: <br />PEO PEO PEO <br />PEO Information Name Phone Email <br />Insured by Carrier <br />Policy Holder Name: OVERLAND PACIFIC & CUTLER LLC <br />Insurance Carrier: H6rtfi Underwriters Inspmnce Co. <br />Policy Number: 10 VIE A59914 <br />Inception date: 08/10/19 <br />Expiration Date: 08/10/20 <br />About DIR <br />Who we are (https:/Avww.dir.ca.gw/aboutdir.htmi) <br />DIR Divisions, Boards & Commissions (https:/Avww.dir.ca.gov/divisions_ and_programs.html) <br />Contact DIR (https://www.dir.ca.gov/Contactus.htmi) <br />Work with Us <br />Jobs at DIR (https:/Avww.dir.ca.gov/dirjobs/dirjobs.htm) <br />Licensing, registrations, certifications & permits (https:/Avww.dir.ca.gov/permits-licenses-certifications.htmi) <br />Required Notifications (https://www.dir.ca.gw/dosh/Required-Notifications.htmi) <br />Public Records Requests (https://www.dir.ca.gov/pra_request.html) <br />Learn More <br />Acceso al idioma (http://www.dir.ca.gov//Bilingual-Services-Act/default.htmi) <br />Frequently Asked Questions (https://www.dir.ca.gw/fagslist.htmi) <br />Site Map (https:/Avww.dir.ca.gov/sitemap/sitemap.htmi) <br />25D-95 <br />https:Hcadir. secure.force. com/ContractorSearch/registrationSearchDetails?id—al Rt000000... 6/30/2020 <br />