PROOF OF INSURANCE (2016) CLOSEDit
c/61�bWACS, Int.
e.
Po Box 257'
DESCRIM0, POLIMS O,.
- «'
r:
- Policy # CIP239821
GCrryiMERMAL r~rEOE RAL LIAWILITY
00 20 33 04 13
THIS ENDO EMIE T CHANGES THE-POLICY, PLEASE DE =AD IT CAREFULLY.
This endorsornent modifies inzurerm provided aincJ6�r the tollovj:nol-
CCMMERCIAL GENERAL LIABUTY COVEPAGE PART
A, $action li — ' Who is An lrmsirted I$ aayrronded, to
fnoWds as an additional hisursd any peown air
orpunixation %r iwhorn you are I arfCrrra iriii
orseratioris Miert you "recd' such person of
orfiarsi atiori have aoreatd in writing in 4a contrscrt or
agreerhent thst -such pereon or organization tie
added as an additional insured on your polldy.
80011 Person or Organization Jr, an sdditlontai
lnaurred only 4h respeol to tltaiaitity for "budily
injury " 0property da oe`" , "personal end
adwedts,i d isju " oauted, in wilwAo or in part " by:
1, `foraacis- or,omi'ssions; or
2, Tbe: seta or amiss ions of those acting o,jj yourr
taehtalC„
In the poriorr ante of your'ongoing! oiderations for
1110 dditicanad insured.
liow p r, the, insurance afforded to seoir
adc9ilonral insured -
1. on y "appli", -to We 0„ eni W?-7ftted by ,asap,
and
2. #Pauli not be broader than Mat wriiich yov are
required by the oontraot or soreernent to
provide for such adoidiitinal inscired,
A N
er on's tat oroandzetion`rs st lus as all
addiiotiai insured under this en ddrse ortt We
when yoair operations for that additional 9rieured
are cornpieted
S. With respect to the insurrrl'ace afforded to ftbe
addlWriol insureds, the 'oUov ing aoditionar
exclusions aped y:
TI) rnsur.0 nee does not apily to
1. "Bodily Injury", "properly dsrna9e." or " °psrsonsl
and a vodisino injury" arising out of the
rendering of, or the faldure to ronciet, any
professional arcl4teoturol, erigineorino .or,
sviveyino.sorvlaes. iiidluttino,
a. The preparing, .jppro0nG,- or iaifirig t�
prepare or approve, maps, shop dr whirs,
opinions, reporm, surveys. fdefrl orcders, .
cban e order ^s or draawwirras and
si�eitioart6ons# or
t�. upervdsory, trispadtdon, arwiltetural or
drrotraaaeririg aaivlties:
`fhi"s ex0ltrairrri appiias even T the, clolais aptairmst
any Insured aiteoe neoligonce or other, wrrarafdtioIng,
in the iupepAsiori, Hiring" ernptoynsent" training or
mronito Q of oi�liers by that insured, If the
"oo urrra'aaoo "° whi(ih oravapo tlir 1041 iy u1jory "o '
PxproprMrty darn0se°" or the offen "° se whidi errtrsed
The "personal rend radwrrrd;isirao inju y " insreiwerd tile
rendering of or the failure to render any
pragseidnal proliitecttirai, enoriisrsdto, or
avrveyirio seriadr s.
CG 20 33 -04 13 0 frisi rf1m.. rvir68 OffiM tnc , 2012 Pago 1 of .2
` odliy Injury r "Prvrmaty dwnarge," o,�vgrrsn
after
a. All worth, Including 1118tarlats, prlS or
ecIdipment furnished In 4}ennraotion witil
such work on the r je t (fatties' than
elvice, tatlalrneh noa or. rapafrs) to be
performed by 'or on behalf o ttta ttdd @ "tionat
isasurcri(a) gat the, lraoratfora of the covered
Wee ahofls has Irian COMp feted; or
b, That paortlora t "Yqurr YwVk' oirt of Which the
injury or darnaga arises has wen paut to its
intandad Im by any person or or ,anizatdo¢a
other than another vontr ator or
subcontmotor an aged In performing;
;
'Operattoris for 'a Principal as ra vast of the
sam a paroj ot,
i� With re eat to the isi arance dtforded to these
dit n lnsureds, the fol6cmAdpi is added to
avtton ttl - t.ttttlts Of ItIstiftitvt e.*
'rile rraosi we vrlll pay un bataalf of the Additional
insured Is the aMpuilt of insarraarva.,
1, Required by the onlra' of or a reemank you
ha�v antemd Into yi'sth the additional lnsasmd
or
i Available under than ap laiieable timtts of
tnsur, ante voo n in the Deolaravons*
whichever is lbs.
This nd rsert� tarot shall not increase the
001otabla t,lr$ts of snsurranve ahoVM in the
eraletatiorm
pave org, Inswanoa ervi % offlce, irav,, 2Cf,2 `y 04
PRIMARY AND NON-CONTRISUTING INSURANCE
(Third-Party's Soile Negligence)
lbaIndomement mwifies 4MUMICe fxo ded under the 49 tti4wrWl�;l
The follamni; is adow to section jv -�,,orrirnefcial General, Uabifily Condi It lofia, Pftgraph-4
SecOn IV' Comineirclat General Uabiltily, Ckindjjj0qs
4. OtMer Insumnoo.
4 Notwitlistarlding time prwslons of sub'-pamoraphs 8,, b, and 0 rat thins Immoraph 4, Wh respect to
Me Third,PaAy shoNn bek7g, it is uriderstood, and agreed that in the evert ofe ofal(n (x,lsug"
adsing out, of th6 Named haureft sole rte dtilgence, thit insumnce Omit be, pdmop/ and arty other
invuronge "laintrMiled by the vd6tjo4 insures named ante Third Party below shall be excesu
The Thild Party to whw Ws wdomement apoes is:
ANY PFOS64 OR ORGANiZATiON WITH W')JOM THE W$URED HASAGREI-E-0 SY WRITTEN
CONTRACT TO PERFORM SERV=-S ANO PRIOR To Afrt LossfHAT ARE WrHINIKE TERM 'S
AND CONDITIONS OF THIS POUCY To WHICI.i n1jS FORM IS Xrfk>1150,
Abeenoe of a speoffically, neaned Third Party abaw means that time par,' SIOns of tits endoroament
W;Y,145 required by WhItan contractual 490181"ant ^Mih any Tbj(d Party florwhom You are *foiming
Work,
All Wer terms, and conditions of ift polipy, remain Unclianged.
This endorsemunt 1% Offectlw on the inQeptiop date of the pciiGy unless oU3e*se staleo, nenein, (Tbue
Inf0f(Illation Wow fs roquired only volloti this ,enOrsement to issued gul*oquent to preparation of the
Policy.)
PoWy Wfnber,,' CI P2$9821
Namedensured: HADRONEXfW.,
Efr�rseroent Sffocli* Date: 0MV2016,
Includes c0pyrt"ght0d MUtOrlill Of lnsuranc* SWMCPS Offlea, Inc. Nvith its porm$sslon
Oppyri,ght, insurance somoas ofticeinc. 1994
KITH DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE R001 8/28/2015
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(ies) must be endorsed. If SUBROGATIONIS 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).
PAYCHEX INSURANCE AGENCY INC /PHS
210756 P: F:(888) 443 -6112
PO BOX 33015
SAN ANTONIO TX 78265
INSURED
HADRONEX INC
2067 WINERIDGE PL
ESCONDIDO CA 92029
COVERAGES CERTIFICATE NUMBER:
INSURER C
INSURER D
INSURER E
INSURER F
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.
/NSR
TYPE OF INSURANCE
AD DL.SUBR
POLICYNUMBER
POL/CYEFF
POLICY EXP
LIMITS
rTn
WI?
(MM/DD/YYYY)
iuil,rmnrvvvv,
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
g
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
,
PREMISES (Ea occurrence)
MED EXP (Any one person)
y
PERSONAL & ADV INJURY
GE 'L AGGREGATE LIMIT APf� 1ES PER:
GENERAL AGGREGATE
$
POLICY PRO 0 LOC
JECT
PRODUCTS - COMP /OP AGG
OTHER
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$
(Ea accident)
BODILY INJURY (Per person)
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
HIRED AUTOS NON -OWNED
PROPERTY DAMAGE
AUTOS
(Per accident)
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$
DECi IIETENTION f
WORKERS COMPENSATION
X PER OTH-
ANDEMPLOYERS'LIABILITY
STATl1TE ER
ANY PROPRIETOR /PARTNER/EXECUTIVE YIN
E,L,. EACH ACCIDENT
J 1/ 000,000
A
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH) ❑
NIA
76 WEG GH3220
10/01/2014
10/01/2015
X
E,L.DisEASE -EA EMPLOYEE
0, 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.,L., DISEASE - POLICY LIMIT
0 0 0 0
F�o /
DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Those usual to the Insured's Operations. Blanket Waiver of Subrogation applies
per Waiver of our Right to Recover from Others Endorsement WC000313 attached
to this policy. Notice of cancellation will be provided in accordance with
Form WC990394 attached to this policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
CITY OF EL SEGUNDO
(d DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
ATTN• PW DEPT AUTHORIZED REPRESENTATIVE
350 MAIN ST
EL SEGUNDO, CA 90245
C0 1'988 -20114 ACORD CORPORATION. All
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
SM . t"ONUNYYYY
R10 2 2 8 /2 5 /20 1`5
CERTIFICATE OF LIABILITY INSURANCE
THIS CEATtFICAT91S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDERJHIIS
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,
$MPORTANT; if the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed, If SUBROGATIONIS WAIVED, subject to the
terms and conditions of the policy,, certain policies may require an endorsement. A statement an this certificate dogs not confer rights to the
—cartificate holder In lieu of such endorsernenk(s).
, wll�� (888) 443--6112
PAYCq1KX --;.h'SURANCF.-,' AGEN(.-'Y ENC/PHS Tlk—lllt I"
E UAft, I
2 100.5) 6 P . F' 816 ) 4 4 3 - 6 1 1 .L 2
Po aox 3�01�5 *0jVe%;t AVRNIDING C*VC �OrF
SAN ANTON'10 TX 78265 Co
. ............
rMED
HIADRONEX T1\fC
8Yf 11.
2067 Wit,4ERIDGE PL
ESCONDI,DIO CA 92029
COVERAGES CERTIFICATE NUMBER. REVISION NUMBER*
THIS IS TO CERTIFY THAI" THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 11,1E INSURED NAMED ABOVE FOR THE POLICY PERIOD
JI4DICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONLItTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH ��,Is
CERTIFICATE MAY BE !S$UEO 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 SEEN REDUCED BY PAID CLAIMS,
Pok VA *M
COMMERCIAL GENERAL LIABILITY
gwjz.
CLAIPAS-NAADE OXCUR R00 nmw-w,�o
El
PERSONAL & AW INJURY
GE,1401 %L A4
GENII, AGOREGMTE I. tMIT APPLIES PER
POL PRO. Lac
OTHFA;
AUTOMMLE LIABILITY
ANYALTO
ALL OWNED SCHEDULE[) acoa:? NJURY (flat 4wmlk"I
AUTOS AUTOS
NON4MNED
KIREDAUTOS 90. rFCC�n',lenakt
EA(Ai OCCUMIENCE
UMBRELLA LIAR OCCUR
EXCM UAS CLAIMS-MADE
.. ........
. .... ... . .
YIN E. L. EN-'Ii A-00 E'A I1, 000, ()00
(.XIIIUKIJVVI NIA 0 J F11 r?-, wWSEAMSE. EA '1, 0()0, 000
A 0,1and4f" M M)
1, 000, 0 0 Q
0 ESCR IPTIOti OF OPFAA7 I(XIS bakw
0 U a.'. .o t ii e in 3 ureO, S OPX rR L 1 o 11 S
CERTIFICATE 14OLDER CANCELLATION._
SHOULD ANY OF Ttl IE ABOVE DESCRIBED POLICIES BE CANCELED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WI'S'H PROM IONS.
ci,cv of El segwad.o -WVW0R;t6 REPPEARATR
1.50 ILI'INOIS ST `7
'El, SEGUNDO, CA 90245
C 1988.io-14Af6RD —CORPORATIOW AlFighis roserved,
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
"In
W, M/i v,
Policy Number: 76 WEG GH3220 Endorsement Number, 05
Effective Date: 08/28/15 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: HADRONEX INC
2067 WINERIDGE PL
ESCONDTDO, CA 9209
We have the right to recover our payments from anyone liable for ai injury covered by this policy. We will not
enforce our right against the person or organization marred in the Schedulle, (This agreement applies only to the
extent that you perform work under a written contract that requires y(.'Au to obtain this agreement frorn us,),
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall
premium otherwise due on such remuneration. I
U-T+ = +�
ANY PERSON OR ORGANIZATION
FROM WHOM YOU ARE REQUIRED BY
WRITTEN CONTRACT OR AGREEMENT
TO OBTAIN THIS WAIVER OF
RIGHTS FROM US.
CITY OF EL SEGUNDO
AT TN. FLORIZA RIVE RA, PW DEPT
350 MAIN ST
EL SEGUNDO, CA 90245
5 % of the California workers' compensation
Job Description
BLANKET OPERATIONS
ENGINEERING PLAN CHECK
SERVICES.
Countersigned by
Authorized Representative
Form WC 04 03 06 (1) Printed in U.S.A.
Process Date: 0 9 / 01 / 15 Policy Expiration Date- 10/01/15
ESCt1'"PU'K CA 97ta75
1.760445.5151
Policy number' 62,64245 »7
Underrwr'men by,.
U'11TED t,PIAdCCr G (ASUr WCOMP;ANY
SC7 20,20 is
pgts "P of p
ertaa"trr�te Mohler Insured!
Agent
C:1I"r �1p CIa�AE�I"9t1 ilr�et�l�l� fI11C'IPC"�fEld�iSt11C1�iC�'
QO FOX KS 7067 WINlwld6it E RACE #E 725 E `JAL' LEY Ply`
Pt196057 ESCCIrdi7 VOt CA 92029 CSCClr 0100 (A 92025
PORTIa NO, M1 44820
This document certifies that insurance pralines id ratiNd tae1mv, have been issued its the,de5ignamd insurer lo,the insured
nnnanti abovefor than period() indicated. 11a1s Certsali tu'i's issartd fear infrrrraaation purooses only. It ralnfarrs no ri hts capon
the Certificate holder and, doe carat (haange, Act modify, of extend the coverages afford d by the poles listed below.,
'thy cover6yes. affrrttled by lire policies llste� below are sac j tt to oll ate Para Ins,, exclusions, limitations, cndtrcsernen , and
covdllions'-df these polid s.
'ill yEffrral� aaa . aB tZ IM �Ut' ...x .a.., .. ...., Poky Expiration Date, re- f, '2666 , , ..x,.. „,a ... „ , .. a ........
anxuararr�a aCww�rr�a��,1 Clr�ai
ti il5 Pt lUltkJPI P 1a II P St 4 q tt1P tII iCl1 SBPaCrfF
UNIT
.....v. �xx.i x,a
to 1IPISUICfi7da Nd176PIPi iPd6ll I PS `„ 5' ti000C 1 $l$l,NC i8 6i.6:iiii`f
...n .... m +r.lpM ,. ed{.,� «{xy�I} �^'y^.�y.�j... {x�w, �.;'¢r �,y.f.",g,;ep q mya�x7111
L9 "Y ➢Y'tF.,W9R Pt ,wN' P4 4'W'"'1.J 14'AFNMA k.�L.P 4l�L'4�d� «" 00.000' " "�"�'FMV rewlwPi�WMGW'i'6 v""Yd"iW�'iE»P, 0.PP 9 .. .
•_.. .. .r• .. ., nrr w <' w rxr , .fir. en r. ,. a •. wr w. •r • ,r,.s trr ,r .. ". .. xn v +:.., r•.rx ....� v u,. .,rv,.,. � *.'"
taPldEtt�Atl1" S��IP wttdPtl'"a�1Pd�l�P�"taaP!,C.o .,..tnUt�YtldCPw��tr�dtP�51i�P t.PSrtP"t
eba:ai.aal+ti a�aatc� ctnf�r
2011 poi'dd7: 1 6a 'iFTMIAOXBPJa5751
l'EIIIC4 PAYMENTS
C MPIdtHE SIIJE $500 DED
COWSION $500 WAIVER DED
Certificato number
r
14015NET 45
Please be advised that the certificate holder will not be natified in the event of as raid -term cancellation.
fW M 5141 Oft?)
aRrltd VERt01SU1,UMC
225 F VAttEY PKWY
ESt:ONt0 UM s2t025
Policy nranllrer 06264246-7
v'r1r1vrllrrrtterw by.
U111ttr1 miler dal; (ASUaRy Compa'n'y
Ins6wext, HADAMU 1KC
0tADltONEX INC May 20, 2015
2067 VANERIOGE PtAa #f Policy 6W., Rb 10 2015 • Feb 1, 2016
RSC6ND10 0, CA 82025
Malling Address
PO So, 94739
44
« C�e11rr" �� 11�J�t
l'° i
11-800-444-4487
for clstmer ;service „.2 4 haatrs a r)ay,
NA m e of par on or O1 r a,n ization 'I days a week
CITY OF SACRAMENTO
PO, BOX 7
POltJIAM , MI 4885`7
The person or 12rg rail tion named above is an Insured with respect to Such Iihlritity cu1re1oge as is
afforded by the policy, but this inswance applies to said insured drily as a pewit liable iet the condoctol
another insured aM therl only to the erien0 of that liability, We also agree voith your that Insurance
pfovided by this endorsement wilt fire primary fus fitly parer wA,speclli(ally descrioed on the
Declarations Page,
Limit-of Liability
Bodily Injury Not applicable
Property Damage Not applicable
Combined liability $1,600,000 each accident
All otherterrns, limits and provisions of °this policy remain Unchanged.
This endorsement applies to Policy Nurntmt: 06264245-7
Issued tat (Maine of lr ureri); HAt RONEX, M
Elfectrolr: date tai endorsement: 05/2012015 Policy exPis"ation date: 021 '11 01
rvm) too cacao)
PAYCHEX INSURMCE AGENCY INC/F-TiS
PO BOX 3301-5
S" ANTONIO TX 78265
Cl.it.-.v o Ell Seyu-,dbc
150 ILLINOIS ST
ACORD 25 (2014101)
"rhlsl,,.--.iidoi.mni,entCJ,iak Ves time Pollcy-Nesse Read It CareAdly
FIRIMARY AND NON-CONTRIBUTING INSURANCE
(Third-Party's Sole Negligence)
71fls undomement r eA knswvrce P° 'fed undw Ow fdlawfta
CXMWETUAL OENEM. L i-,Ascay a.wEFzAGr,.-., PART
OWK- M- ANO WNTRAMMRS PR)TEx,11WE LABLITY awE...,RAGE PARW
PRODUCTS=MPL E"ETED OPSRATMS LJABI rTYCXWERAGr-.,PAF?T'
LIABUTY COVERAGE F'-IAR9'
SLAW[ ERS LABUTY aNEPAGE FORM
711ta fdkwiV m added to Saetlon P - Cominel-OW Geftral I IaWtY 0DWOOM, ftlegraph 4:
Secdon IV. ComirerWal Gonsfal UWAIRV Colitfloolvs
4. Mier lneumm,
the pnwWuns of )uu-✓amoraphs 8, b, mW C W Oft paragyaph 4 ,Pmh rest Am to
Uhle Thrd Party shmn belcw, d rt; uru defstoo(j and agmed that in 11h". wwent Ora o ilm 0; "sult"
wiMrig oW of the Nwrect knsuretfsa ask' o neo4gent.,e, IN 1neutence shat p6mary arw arry other
41wwronce niWntarned lby the addiftmW kwturW namW, as the ThvJ Party txtkm 31,Wt be ammss
and non,"OCMAWWY-
nv'ThM PwW to vdim 098 endmawnent spoiss w
ANY PERSON OR ORGAWATtON Wrr�j W�jom -n4E tNSVRLi--.-D HAS AGREED BY WRF'rEN
M.4TRACT TOMWERPORM If ERVCE-S AND TDR0A TO ANY LOSSTRAT ARE, WM--fl11,jTHE 'rE1'-:,RJW8
AND CONDITIONS OFTHIS P-70LICY "TO WH04 748 FORM 148 ATTACHS).
k arum a SPe.611110,30y natned Thkd NOY 8,bomu, means knat thie pmysiorm d We aador, mki, t
a n
apply "as m0red by wml ten corkmwal agreaqjert wilh any Third Plwl y ft whom you are pvtorening
V+vl( "
All obier to s and cond1hom, of His pDky remWn anal anged,
This undursoment is effeicUmi On the mceptN on data of "je p(Amf.,y uf,mfl ess ottv,�rw�se slat efj 4m0ll, (The
k4ormaliw, IxIoN Is miWed onty v^jr Uft errfor'setylent 16 is-sued SUbstNue1,Q to Ptepwation of Uw.,
Puticy)
Pok..,,y Numtm r OP' 230821
Named Usurad l-4ADRONEX INC
Endormnevit EffWk w- Nlc6.,
EfIdWSLIMefit Wet No, AF 001397 0712
InC,Wdeg COPY110tecl materfal of IIn surance Sommes Office, Inc. wk its jimrmlsolon
OOPYrtght, ISMU'SMce Services Office, Irma 1994
BIROMER WSURAW1
725 E VAUNIMMY
MUMMA (A 92025
1-760-AS-5151
Polity number: 062,64249.7
Ur*rwft" by:
UPOTED RNAWAL (ASUAVIrY C011 M's
AW
May 20, 2015
Rap, I G( I
Owdftrale DOWder h%sured Agent
dN'&'SkrJWAW6 ..... . ............ ...... .......... .. E
UO E X RCS 2067 WINERM )GE M. CE #111i 725 E VAIJ EMM"
PO 9OX 2,57 ESCONDOO, (A 920,29 ESCOM)DO, CA 92025
IM IIAND, 4 48870
11% document, crolfies Irrat kisurance pDlides Wendfied Wow have been u.ssued by the, designated 4isurpf to the Mrrsured
named above for the period(s) ondicaled, TMs Ca6catels 6%ued for Worrna6un purpowsor4y, rt confers ino 6qirls upwl
the cerfificate hddei and does rot diange, after, niodffy, of extend the awwages affaii'drd by dv ptkdes fisted Wow
The covesages afforded by the poNdes Hsted Wow are subjeci to afl the ssssss® exdusiorri, HrMtOons, eindarsements, and
candifions of dmh polldes.
R'bL, 2015' P'o'MMc'y"Ex,p9ra'g"o�i'Da,te'a I`eb '20' 1,65,
D'A'M'E S , I , AM'O 1 00 C 1 0 1 RADNE 1 11 St N , GLE " LI , MIT .. ....
MOTOUST $W0,000 COMMED SsNGU,, UNT
Descflj;IIJon of Lucadon/VehldeOpedal ltcki°ins
Sdieduled autas only,
MEMCM PAYMENFS $5,0(X)
COMPREHENSIVE $500 DE ' D
Crol U901M $500 W/WAJVER IXI')
CertMute, number
14015NET245
Please be advised that the certificate holder will not be notified in the emt of a mid-term cancellation.
M
Fam SJ41 OOMII
rmilt of 1,1abili „
Bodily Injury Not appNpma IPa
Property Damage NotaNNmpllocabk
Conibirsed Uakiflity $1,000,000 each accident
M al-berterms, Hima amid provisions of Oasis policy mvnafim unckanged.
°0"Hs emmdofseifn em apI)Iies to PfAcy Numbo . 06264245-7
Is amp to (NaQmw d' NmmW� red) N DN' ONE) p8' C
Effmve day cl vidwsement 0512012015 kfiq expimakmu dada: 02101/2016
ES ONOWD, 9202
lky nwiniber NNI -
UeM finarKiM Cauffifty U mpany
Nmwak KAORONEX NON
H DROMI' , WC
Wy 23, 201 m
2W? WNEEDGE PIACE Q.,
POky PeflaM Feb 1„ 2015 - Feb N„ 2016
LISCMDOO, 0b 92029
Malling Addrus
PO Ow 979
Additional Insured endorsement
rmilt of 1,1abili „
Bodily Injury Not appNpma IPa
Property Damage NotaNNmpllocabk
Conibirsed Uakiflity $1,000,000 each accident
M al-berterms, Hima amid provisions of Oasis policy mvnafim unckanged.
°0"Hs emmdofseifn em apI)Iies to PfAcy Numbo . 06264245-7
Is amp to (NaQmw d' NmmW� red) N DN' ONE) p8' C
Effmve day cl vidwsement 0512012015 kfiq expimakmu dada: 02101/2016
PAYCHEX INSURANCE AGENCY INC/PHS
PO BOX 33015
SAN ANTONIO TX 78265
ll,)() ILLJNOL ST
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