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Wesco Insurance Company <br /> A Stock Insurance Company <br /> WORKERS COMPENSATION WC 99 00 01 C <br /> AND EMPLOYERS LIABILITY 1 of 5 <br /> INSURANCE POLICY INFORMATION PAGE <br /> Ncci Code : 26135 <br /> 1 . Insured: Policy Number : WWC3560056 <br /> Tank-Tight Systems Inc <br /> 8515 Waterman Road <br /> Elk Grove, CA 95624 _Individual _ Partnership <br /> Other workplaces not shown above : X Corporation or <br /> None <br /> Producer: Risk Id: <br /> Builders & Tradesmen's Insurance Services, Inc. Renewal of: WWC3507896 <br /> 6610 SIERRA COLLEGE BLVD, Suite E <br /> ROCKLIN, CA 95677-0000 <br /> 2 . The policy period is from 12/ 11 /2021 to 12/11 /2022 12 : 01 a.m . at the insured's mailing address . <br /> 3 . A. Workers Compensation Insurance : Part One of the policy applies to the Workers Compensation Law of <br /> the states listed here: California <br /> B . Employers Liability Insurance : Part Two of the policy applies to work in each state listed in item 3 .A . <br /> The limits of our liability under Part Two are: <br /> State Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease <br /> $ 1 ,000 ,000 each accident $ 1 ,000,000 policy limit $ 1 ,000 ,000 each employee <br /> co Other States Insurance : Part Three of the policy applies to the states, if any, listed here : <br /> All states except ND, OH, WA, WY and State(s) Designated in Item 3A . <br /> D . This policy includes these endorsements and schedules : See Extension of Information Page <br /> 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating <br /> Plans . All information required below is subject to verification and change by audit. <br /> See Extension of Information Page <br /> TOTAL ESTIMATED ANNUAL PREMIUM 10 ,588 <br /> STATE ASSESSMENT 419 <br /> TOTAL ESTIMATED COST 119007 <br /> Minimum Premium 500 <br /> Deposit Premium � hUj( f ,0 15476 <br /> Issue Date : 10/27/2021 Countersigned by : <br /> Authorized Representative <br />