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Wescw Insurance Company <br /> A Stock Insurance Company <br /> 874 Walker Rd,Suite C <br /> Dover,DE 19904 <br /> WORKERS COMPENSATION WC 99 00 01 C <br /> AND EMPLOYERS LIABILITY 1 of 4 <br /> INSURANCE POLICY INFORMATION PAGE <br /> Neci Code: 26135 <br /> 1. Insured: Policy Number: WWC3299463 <br /> Nucleus Pump Services <br /> c/o Wightman Enterprises,Inc dba CSL Solutions <br /> 8017 Sacramento Street <br /> Fair Oaks,CA 95628 Individual Partnership <br /> Other workplaces not shown above: X Corporation or <br /> See Extension of Information Page Federal Tax ID: 272777087 <br /> Producer: Risk ID: <br /> AmTrust North America,Inc. Renewal of: WWC3236024 <br /> c/o Risk Transfer Ins.Ag.LLC <br /> P.O.Box 531165 <br /> Orlando,FL 32853-1165 <br /> 2. The policy period is from 10/10/2017 to 10/10/2018 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 the states listed <br /> here:California <br /> B. Employers Liability Insurance:Part Two of the policy applies to work in each stated 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 /> C. Other States Insurance: Part Three of the policy applies to the states,if any,listed here: All states except ND, OH,WA,WY <br /> 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 Plans.All <br /> information required below is subject to verification and change by audit. <br /> See Extension of Information Page <br /> Issue Date: 8/24/2017 Countersigned By: <br /> Authorized Representative <br /> N <br /> ?<U <br /> S <br /> Servicing/Issuing Office:Cleveland <br />