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Class /Payroll <br />Detail <br />SUMMARY OF =NS URANCE <br />Class Coda <br />Payroll #o£ Emp <br />Location <br />rH� <br />CA <br />PLASTIC GOODS MFG - N.O.C. <br />ii�x-rr c�x� <br />FOR: <br />Location <br />01 - <br />P S GS TAS L USA LLC <br />SALESPERSONS - OUTSIDE <br />Prepared . 0 4- 2 6 - 2 0 1 2 <br />1601 E SANNT ANDREW <br />PL <br />01 - <br />SANTA ANA CA 9 2 7 0 5 <br />CLERICAL OFFICE EMPLOYEES -N O <br />8810 <br />Phone: <br />FAX: <br />BY : HOME OFF = CE <br />CJN 2NSURANCE SERVSCES <br />/PHS 135212 <br />PO BOX 33015 <br />SAN ANTON2O TX 7H265 <br />Phone: (866)467 -8730 <br />FAX: (877)905 <br />-0457 <br />ACCOUNT POL 2 CY RECAP <br />Po 1 i cv Numb a r E £ £ Da t e <br />Exp Da t e P re_mium <br />.Workers' Compensation <br />51 WEC DR3209 04302012 <br />04302013 $14,891.00 <br />Hartford Underwriters <br />Ins Co <br />POLSCY DETAIL Policy _ <br />Workers' Compensation <br />Policy States: CA <br />Location 02 Prem3sas Address <br />1601 E ST ANDREW PL <br />SANTA ANA CA, 92705 <br />Worker's Compensation CoveraQas <br />Emp 1 ova r' a Li ab i 1 i tv Limit a <br />L imi t <br />Disease - Policy Limit <br />$1,000,000 <br />Disease - Each Employee <br />$1,000,000 <br />Each Accident <br />$1,000,000 <br />Sndividual <br />2ncluded /Excluded <br />Class /Payroll <br />Detail <br />Class Description <br />Class Coda <br />Payroll #o£ Emp <br />Location <br />01 - <br />CA <br />PLASTIC GOODS MFG - N.O.C. <br />4478 <br />$126,300 <br />Location <br />01 - <br />CA <br />SALESPERSONS - OUTSIDE <br />8742 <br />$40,300 <br />Location <br />01 - <br />CA <br />CLERICAL OFFICE EMPLOYEES -N O <br />8810 <br />$65,300 <br />This Summary and its attachments provides a high level overview o£ policy coverages and <br />does not include all conditions, limitations or exclusions. Please refer to the actual <br />policy forms for detailed coverages, limits and deductibles. <br />Exhibit C <br />