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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />SCHEDULE OF NAMED INSUREDS AND LOCATIONS <br />Item 1 of the Information Page is amended to include: <br />Named Insured <br />Obsidian Group Holdings, LLC <br />Universal Engineering Sciences, Inc <br />Universal Engineering Sciences, LLC <br />Universal Engineering Inspection, LLC <br />Nova Geotechnical and Inspection <br />Services, LLC <br />Nova Geotechnical and Inspection <br />Services - Northern Nevada LLC <br />Nova Geotechnical and Inspection <br />Services - So Cal (a California <br />corporation) <br />IQC Southwest, LLC <br />GFA International. Inc. <br />Contour Engineering, LLC <br />Obsidian Group Acquisitions, Inc. <br />Nova Geotechnical and Inspection <br />Services, LLC, dba Universal <br />Engineering Sciences (Las Vegas) <br />Nova Geotechnical and Inspection <br />Services — Northern Nevada LLC, dba <br />Universal Engineering Sciences <br />(Reno) <br />Nova Geotechnical and Inspection <br />Services — SO CAL dba Universal <br />Engineering Sciences (Irvine, CA) <br />GFA International, Inc. dba Universal <br />Engineering Sciences <br />IQC — Southwest — So Cal <br />Universal Engineering Sciences <br />GEOServices, LLC <br />Location <br />FEIN <br />WC 99 00 15 <br />State <br />Unemployment # <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 5/1/2024 Policy No. RWC3002100 Endorsement No. 1 <br />Insured Obsidian Group Holdings, LLC <br />Insurance Company APPROVED l Greenwich Insurance Company <br />WC 99 00 15 Countersigned by I <br />By Cynthia Mora at 11:17 am, Dec 05, 2024 <br />Ed. 0314 © 2014 X.L. America, Inc. All Rights Reserved. Page 1 of 3 <br />May not be copied without permission <br />