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Insurance - Hadronex Workers Comp 2017-04-05lT`✓v CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 4/5/2017 THIS CERTIFICATEIS 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or 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 PAYCHEX INSURANCE AGENCY INC/PHS 210756 P: F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265. CONTACT NAME: I=. tNFja, Ed): FMC,Ne): (888) 443-6112 AIL ADDRESS: INSURERRH AFFORDING COVERAGE NAIC# INSDRERA: Hartford Accident and Indemnity 22357 INSURED HADRONEX INC DBA SMART COVER SYSTEMS 2067 WINERIDGE PL ST E ESCONDIDO CA 92029 INSURER B: INSURERC: INSURER D. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. LNSR TYPEOFINSURANCE ADBL SV8R FOLICYNUMBER M�LAYF POLICYEXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 CLAIMS -MADE OCCUR DAMAGE TO RENTED S PREMISES (Ea cocumence) MED ESP (My one person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PET ❑ LOC PRODUCTS -COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) y PROPERTY DAMAGE $ (Per accitlenp HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA UAB EACH OCCURRENCE $ AGGREGATE $ HOCCUR EXCESS LIAB CLAIMS -MADE DEo RETEN[i $ WORR£RSLOMP£NSATION ANO£MPLOYERS'LLASLLITY X PER OTH- STANTE ER E.L. EACH ACCIDENT $ 1, 0 0 0, 0 0 0 ANY PROPRIETORIPARTNERIEXECUTIVE YM A OFFICERAMEMBER EXCLUDED? (ManCatoryln NH) MIA 76 WEG GH3220 10/01/2016 10/01/2017 E.L. DISEASE -EA EMPLOYEE 11,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 51, 000, 0.00 DESCRIPTION OF OPERATIONS ILOCARONSIVEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. COSTA MESA SANITARY DISTRICT AUTHORTLEDREPRESENTAIME 290 PAULARINO AVE COSTA MESA, CA 92626 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORL� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 4/s/zo17 THIS CERTIFICATEIS 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or 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). P OOUCER PAYCHEX INSURANCE AGENCY INC/PHS 210756 P: F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 EON. NAME: INC,PHONE FAX No, En), (Kc,Na): (888) 443-6112 AIL ADDRess: INSURERS) AFFORDING COVERAGE NAICN INSURER A: Hartford Accident and Indemnity 22357 INSURED HADRONEX INC DBA SMART COVER SYSTEMS 2067 WINERTDGE PL ST E ESCONDIDO CA 92029 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE APDL SURR PoL(CYNUMR£R PPLICYEFF MM/PD PoLICT£XP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE —1 OCCUR DAMAGETORENTED $ PREMISES (Ea occurrence) MED EXP (My one person) $ PERSONAL B ADV INJURY y GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s PRO - POLICY PRO LOG PRODUCTS -COMPIOP AGO $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Par pawn) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) y PROPERTY DAMAGE (Per accident) $ HIREDNON-OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR OCCUR EACH OCCURRENCE y AGGREGATE $ EXCESS LIAB CLAIMS -MADE OED RETENTIONS $ WPRRERS COMPENSATION A.YO£MPLOYERS'LMILLITY X. PER DTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNERIEXECUTIVE YIN A OFFICERIMEMBER EXCLUDED? (Mantlafoly/n NH) ❑ ARA 76 WEG GH3220 10/61/2016 10/01/2017 E.L. DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe underE DESCRIPTION OF OPERATIONS below L DISEASE- POLICY LIMIT 11,000, 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be allached if more space Is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. COSTA MESA SANITARY DISTRICT AUTHORIZED REPRESENTATIVE 290 PAULARINO AVE COSTA MESA, CA 92626 ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD