OMRON SCIENTIFIC TECHNOLOGIES INCORPORATED

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1 omron OMRON SCIENTIFIC TECHNOLOGIES INCORPORATED Ee Declaration ofconformity sti In accordance with the EMC-Directive (2004/1 08/EC) the Machinery Directive (2006/42/EC) and with the RoMS Directive (2002/95/EC), Omran Scientific Technologies incorporated (at 6550 Dumbanon Circle, Fremont, CA , U.S.A.) hereby declares that the products listed below confonn to the following European standards. SR Series: Safety Relay Modules: SRIOIAOx, SRI02AMOx. SRI03AMOx; SRIOSEOx. SRI06EDOx, SRI07ADOl, SRI08ADOl, SRI09ADOl. Two-Hand Control Safety Relays: SRI04POI. SRIQ4P02 (The products will be marked with the CE-Mark according to the machinery directive. The use to these products within a machine does not guarantee that the entire machine corresponds to European directives.) EN ISO : AC: Safety ofmachinery. Safety-related parts ofcontrol systems. General principles for design. EN 62061:2005+AC:2010+Al: Safety of machinery. Functional safety ofsafety-related electrical. electronic and programmable electronic control systems (for SR I0 I, SRI02 SRI03 SR IOS SRI06). EN 62061: Safety of machinery. Functional safety ofsafety-related electrical, electronic and programmable electronic control systems (for SR 104, SR107. SR I08 SR I09). EN ISO : Safety ofmachinery - Safety-related parts of control systems - Part 2: Validation (for SRI04 SRI07 SRI08 SRI09). IEC :2004+Al: Low-voltage switchgear and controlgear. Control/circuit devices and switching elements. Electromechanical control circuit devices (for SRI 04 SR 107 SR I 08 SR I 09). No. ofcertificate: / /14 (for SRIOIAOx, SRI02AMOx, SRI03AMOx) No. ofcertificate: 968/EZ /14 (for SRI05EOx) No. ofcertificate: 968/EZ /14 (for SR I06EDOx) No. ofcertificate: /5080/10 (for SRI 07ADO I, SR I 08ADO I. SR I 09ADO I) No. ofcertificate: /5083/11 (for SR 104P01, SR I04P02) Notified Body: NB 0035 TOV Rheinland Industrie Service GmbH - TOV Rheinland Group Am Grauen Stein, Koln, Gennany Dale 30.J""",e: 201'5 Fremont. CA, 94555, USA DOl' 0 ~ \ L< \ ' 'S-Hcnogenbo@Ch-Th l\4thelarlds Signed. C:.0~ Martin D. Krikorian Quality Director (Authorized Signer of Declarations of Conformiry) OMRON Scientific Technologies. Inc. RepresentatIve ljl' U J.J P W Vogelaar European Qmifity & Environment Operations Manager Omron Europe B.V Zilverenberg GM. 's-henogenbosch. The Netherlands DECL-OOOO44. Revision I (Reference Document No )

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3 A ZERTIFIKAT CERTIFICATE No.: 968/EZ /14 Product tested Contact Extension Unit Certificate OMRON Scientific holder Technologies, Inc Dumbarton Circle Fremont, CA USA Type designation SR105E01, SR105E02, SR105E03 Codes and standards EN ISO : AC:2009 forming the basis of EN 62061: AC: testing A12013 Intended application Use in safety related applications. The contact extension unit SR105EOx fulfils in combination with a suitable basis safety unit of the OMRON SR 1OxA-series the requirements for PL e I Cat. 4 ace. to EN ISO and SIL 3 ace. to EN and is suitable for use in applications up to PL e and SIL 3, if the feedback contacts are properly monitored. Specific requirements The instructions of the associated Installation and Operating Manual shall be considered. ụ This certificate is valid until Type Approved ID The issue of this certificate is based upon an examination, whose results are documented in report-no.: 968/EZ /14 dated The holder of a valid licence certificate for the product tested is authorized to affix the test mark shown opposite to products, which are identical with the product tested. " KOln, TOV Rheinland Industrie Service GmbH Bereich Automation Funktionale Sicherheit A", Grauen Stein ("'" Certification Body for FS-Products Dipl..lng. Stephan Hab

4 TOV Rheinland Industrie Service GmbH Ii!.. Precisely Right. LICENCE CERTIFICATE for TOV Rheinland Test Mark Licence holder: No. 968/EZ /14 Manufacturer J manufacturing plant: OMRON SCIENTIFIC TECHNOLOGIES, INC. H. Zander GmbH & Co. KG 6550 Dumbarton Circle Am Gut Wolf 15 Fremont CA Aachen United States of America Germany Date of application: File ref.: Date of issue: /EZ 39901/ Test Mark: For products that are in conformity with the certified product described, Type Approved below, the holder of this Licence Certificate is authorized to use the TUV A Rheinland Test Mark shown on this page by affixing the same to the product and by using it in print and electronic media for information and advertising purposes for the certified product. All terms of the currently (.) valid Regulation of Certification and Test Mark Regulation have to be ~ considered. ID The validity for use of the Test Mark is bound to the existence of a valid certificate for the certified product. Annual fee units for use of the Test Mark: Units of fee: 2 Certified product, identification of the device: Kind of product: Contact extension unit Type designation: SR105E01, SR105E02,SR105E03 Technical data: Supply voltage: Max. switched current: SR 105E03 - AC 230 V (50-60 Hz) SR 105E02 - AC 115 V (50-60 Hz) SR105E01 - AC/DC 24 V (AC: Hz) 6 A (250 V, resistive load) 14 A (230 V, AC-15) 1,25 A (24 V, resistive load) 12 A (24 V, DC-13) Contacts: 3 forcibly guided and redundant safety contacts (13-14,23-24,33-34 NO), 1 diagnostic contact (S23-S24: NC) Special remarks: Report-No.: 968/EZ /14 and Certificate-No.: 968/EZ /14 dated Date TO\/ Rhcin!and Indu31rie :2rvice GnlbH fj81"cich Autorn:::l1ion FUI',ktiona!e Sichcrhelt Am G,a'-,en Stein, Kaln Stamp of the Certification Body Dipl.-Ing. Stephan Hiib Vorlage Genehmigungsausweis TA_E Stand

5 Ii!.. ZERTIFIKAT CERTIFICATE No.: 968/EZ /14 Product tested Contact Extension Unit with Certificate OM RON Scientific time delay holder Technologies, Inc Dumbarton Circle Fremont, CA USA Type designation SR106ED01, SR106ED02, SR106ED03 Codes and standards EN ISO : AC:2009 forming the basis of EN : AC: testing A1 :2013 Intended application Use in safety related applications for controlled machine stop acc. to EN stop category 1. The contact extension unit SR106EDOx fulfils in combination with a suitable basis safety unit of the OMRON SR10xA-series the requirements for PL d I Cat. 3 acc. to EN ISO and SIL 2 acc. to EN and is suitable for use in applications up to PL d and SIL 2, if the feedback contacts are properly monitored. Specific requirements The instructions of the associated Installation and Operating Manual shall be considered. This certificate is valid until Type Approved ID The issue of this certificate is based upon an examination, whose results are documented in report-no.: 968/EZ /14 dated The holder of a valid licence certificate for the product tested is authorized to affix the test mark shown opposite to products, which are identical with the product tested, Koln, TOV Rheinland Industrie Service GmbH Bereich Automation Funktionale Sicherheit f\.- ""~~.,~p ::::::,oi,." 51lr)S K,:.:I... Certification Body for FS-Products Dipl.-Ing. Stephan Hab

6 TOV Rheinland Industrie Service GmbH ~ TOVRheinland Precisely Right. LICENCE CERTIFICATE for TOV Rheinland Test Mark Licence holder: No. 968/EZ /14 Manufacturer 1manufacturing plant: OMRON SCIENTIFIC TECHNOLOGIES, INC. H. Zander GmbH & Co. KG 6550 Dumbarton Circle Am Gut Wolf 15 Fremont CA Aachen United States of America Germany Date of application: File ref.: Date of issue: /EZ / Test Mark: For products that are in conformity with the certified product described A Type Approved below, the holder of this Licence Certificate is authorized to use the TOV Rheinland Test Mark shown on this page by affixing the same to the product and by using it in print and electronic media for information and advertising purposes for the certified product. All terms of the currently ~"J TOVRheinland valid Regulation of Certification and Test Mark Regulation have to be ~ considered. to The validity for use of the Test Mark is bound to the existence of a valid certificate for the certified product. Annual fee units for use of the Test Mark: Units of fee: Certified product, identification of the device: Kind of product: Contact extension unit for time delayed safety related emergency stop applications (stop category 1 acc. to EN ) 2 Type designation: Technical data: Supply voltage: Max. switched current: Contacts: SR106ED01, SR106ED02, SR106ED03 SR106ED03 - AC 230 V (50-60 Hz) SR106ED02 - AC 115 V (50-60 Hz) SR106ED01 - ACIDC 24 V (AC Hz) 6 A (250 V, resistive load) 14 A (230 V, AC-15) 1,25 A (24 V, resistive load) 12 A (24 V, DC-13) 3 forcibly guided and redundant safety contacts, 1 diagnostic contact Special remarks: Report-No.: 968/EZ 40001/14 and Certificate-No.: 968/EZ /14 dated Date TOV Rheinland Industria Se:-vice GmbH BCI ~ich Automation Funktionale Sicherheit Am Grauen Stein, K61n Stamp of the Certification Body Dipl.-Ing Stephan Hab Vorlage Genehrmgungsauswels TA_E Stand:

7 ZERTIFIKAT CERTIFICATE Reg.-Nr./No.: 01/205/5083/ Prl.ifgegenstand Zweihand-Sicherheitsrelais Zertifikats- OMRON Scientific Product tested 2-hand Safety Relays inhaber Technologies, Inc. Certificate 6550 Dumbarton Circle holder Fremont, CA USA Typbezeichnung SR104P01 (092091), Type designation SR104P02 (093600) Prl.ifgrundlagen EN 574: A1 :2008 EN ISO :2008 Codes and standards EN ISO : AC:2009 EN : A1:2009 forming the basis of EN :2005 GS-ET- 20:2009 testing Bestimmungsgem~me Die Produkte erfullen die Anforderungen der PrUfgrundlagen (Kat. 4 I PL e nach EN Verwendung ISO , SIL CL 3 nach EN 62061, Typ III C nach EN 574) und k6nnen in Intended application Anwendungen bis Kat. 4 I PL e nach EN ISO und SIL 3 nach EN eingesetzt werden. The products comply with the requirements of the relevant standards (Cat. 4 I PL e ace. to EN ISO , SIL CL 3 ace. to EN 62061, Type III C ace. to EN 574) and can be used in applications up to Cat. 4 I PL e ace. to EN ISO and SIL 3 acc. to EN Besondere Die Hinweise in der zugeh6rigen Installations- und Betriebsanleitung sind zu Bedingungen beachten. Specific requirements The instructions of the associated Installation and Operating Manual shall be considered. Es wird bestatigt, dass der Prufgegenstand mit den Anforderungen nach Anhang I der Richtlinie 2006/42/EG uber Maschinen ubereinstimmt. It is confirmed, that the product under test complies with the requirements for machines defined in Annex I of the EC Directive 2006/42/EC. Dieses Zertifikat ist gultig bis This certificate is valid until Functional Safety Type Approved Der PrOfbericht-Nr.: 968/M /11 vom ist Bestandteil dieses Zertifikates. Der Inhaber eines for den PrUfgegenstand gulligen Genehmigungs-Ausweises ist berechtigt, die mit dem Prufgegenstand ubereinstimmenden Erzeugnisse mit dem abgebildeten Prufzeichen zu versehen. The test report-no.: 968/M 299,00/11 dated is an integral part of this certificate. The holder of a. licence certificate for the product tested is authorized to affix the t ~'E:!"~,iPJj opposite to products, which are identical with the product ~e:o. I}0'., ~ (~! /-.. Berlin,

8 TOV Rheinland Industrie Serivce GmbH Precisely Right. LICENCE CERTIFICATE for TOV Rheinland Test Mark No. 968/M /11 Licence holder: Manufacturer: OMRON SCIENTIFIC TECHNOLOGIES, INC Dumbarton Circle Fremont CA United States of America H. Zander GmbH & Co. KG Am Gut Wolf Aachen Germany Date of application: File ref.: Date of issue: /M / Annual Description: Two-hand safety relays for usage in an industrial feeenvironment. units Product tested I Type designation:..., SR104P01 SR104P02 '.. '.>' >i.,..... ii '..iii> AC/DC 24V AC 115V Annual fee for the listed types: 4 The test sample B will be kept by TOV Rheinland Industrie Service GmbH - will be kept by the licence holder for the disposal of TOV Rheinland Industrie Service GmbH Special remarks: Report-No.: 968/M /11 dated and Certificate-Register-No.: 01/205/5083/11 dated This licence certificate is valid until Test Mark: &.. Functional Safety Type Approved The Licence for the using of the TOV Rheinland Test Mark is only valid for the licence holder and can only be transferred from TOV Rheinland Industrie Service GmbH to third persons. The right for the using of the Test Mark is restricted to such products which are described and are examined by TOV Rheinland Industrie Service GmbH appropriately. This Licence certificate has to be given back to TOV Rheinland Industrie Service GmbH if it is being declared as invalid. Furthermore all clauses of the Test Mark Regulations apply Date TO'! Rh~f!!1land ~ndusti1e ~MO(ll GmbH GeschtAftsfeld ASI AtJlrJm3lloo, Sofiyue uoo IntarmeiJonStedlnologle Am GraUl"n Stein, Koln Poslfach K6in Company stamp Dipl.-Ing. Stephan Hab

9 ZERTIFIKAT CERTIFICATE EC Type-Examination Certificate Reg.-Nr./No.: 01/205/5080/ Prlifgegenstand Sicherheits-Not-Aus-Relais Zertifikats- OMRON Scientific. Product tested Safety emergency switching-off inhaber Technologies. Inc. relays Certificate 6550 Dumbarton Circle holder Fremont, CA USA Typbezeichnung SRi07AD01 (092380), Type designation SRi08AD01 (092381), SRi09AD01 (092382) Prufgrundlagen EN ISO : AC:2009 EN : A1:2009 Codes and standards EN :2005 GS-ET- 20:2009 forming the basis of EN ISO :2008 testing BestimmungsgemaBe Die unverzogerten Kontakte der Sicherheitsrelais erfollen die Anforderungen for Kat. Verwendung 4 f PL e der EN ISO und SIL 3 f SIL CL 3 der EN Intended application Die abfallverz6gerten Kontakte der Sicherheitsrelais erfollen die Anforderungen for Kat. 3 f PL e der EN ISO und SIL 2 f SIL CL 2 der EN The undelayed acting contacts of the safety relays fulfil the requirements for Cat. 4 f PL e acc. to EN ISO and SIL 3 f SIL CL 3 acc. to EN The time-delayed SWitching-off contacts of the safety relays fulfil the requirements for Cat. 3 f PL e ace. to EN ISO and SIL 2 f SIL CL 2 ace. to EN Besondere Die Hinweise in der zugehorigen Installations- und Betriebsanleitung sind zu Bedingungen beachten. Specific requirements The instructions of the associated Installation and Operating Manual shall be considered. Es wird bestatigt, dass der PrOfgegenstand mit den Anforderungen nach Anhang I der Richtlinie 2006f42/EG Gber Maschinen Obereinstimmt. It is confirmed, that the product under test complies with the requirements for machines defined in Annex I of the EC Directive 2006f42fEC. Dieses Zertifikat ist goltig bis This certificate is valid until Functional Safety Type Approved.. Berlin, Dipl.-Ing. Eberhard Frejno

10 rov Rheinland Industrie Serivce GmbH Precisely Right. LICENCE CERTIFICATE for rov Rheinland Test Mark No. 968/M /10 Licence holder: Manufacturer: OMRON SCIENTIFIC TECHNOLOGIES, INC Dumbarton Circle Fremont CA United States of America H. Zander GmbH & Co. KG Am Gut Wolf Aachen Germany Date of application: File ref.: Date of issue: /M / Annual Description: Safety related emergency switching off relay for usage in feean industrial environment. units Product tested / Type designation: i\ i> >i Type I....> '<;;",,:.. 1\ SR107AD01 AC/DC 24V, 3 non-time del.! 1 time-del. contact 1-30s SR108AD01 AC/DC 24V, 2 non-time del.! 2 time-del. contacts 1-30s SR109AD01 AC/DC 24V, 1 non-time del./ 3 time-del. contacts 1-30s Annual fee for the listed types: 4 B The test sample will be kept by TOV Rheinland Industrie Service GmbH - will be kept by the licence holder for the disposal of TOV Rheinland Industrie Service GmbH Special remarks: Report-No.: 968/M /10 dated and Certificate-Register-No.: 01/205/5080/10 dated This licence certificate is valid until Test Mark: &.. Functional Safety Type Approved The Licence for the using of the TOV Rheinland Test Mark is only valid for the licence holder and can only be transferred from TOV Rheinland Industrie Service GmbH to third persons. The right for the using of the Test Mark is restricted to such products which are described and are examined by TOV Rheinland Industrie Service GmbH appropriately. This Licence certificate has to be given back to TOV Rheinland Industrie Service GmbH if it is being declared as invalid. Furthermore all clauses of the Test Mark Regulations apply Date TUV RhGinland Inclustne Senfiom GmbH GescMftsfeld ASI AutomaJoo, SolIl}{"'cro liild Infam~IllO!agre Am Gruur~n Stein t(6ln PosI1ach Min Company stamp Dipl.-lng. Stephan Hab

11 NRNT.E Switches, Industrial Control Page 1 of 1 5/28/2014 Page Bottom NRNT.E Switches, Industrial Control Switches, Industrial Control See General Information for Switches, Industrial Control OMRON SCIENTIFIC TECHNOLOGIES INC 6550 DUMBARTON CIR FREMONT, CA USA E Investigated to ANSI/UL 508 Class 2 limit switches Model(s) HP2008 (#), HP2011 (%) Evaluation units, safety relays, open type Model(s) CM-S2, CM-S30, CM-S4 Limit switches Model(s) T4012 Series, T4016 Series, TL4019 Series, TL4024 Series Limit switches, Class 2 Model(s) T2008 (&), T2011 (@) Monitoring devices Model(s) EC-S Series Read heads, safety relays, open type Model(s) CM-S1PC3, CM-S1PC5, CM-S2PC3, CM-S2PC5, CM-S3PC3, CM-S3PC5 Safety relays, open type Model(s) SR10-1A01, SR10-1A02, SR10-1A03, SR101A01x [+a], SR102AM0x [+a], SR103AM0x [+a], SR104P01, SR104P02, SR104P03, SR104P0x [+a], SR105E0x [+a], SR106ED0x [+a], SR107AD01, SR108AD01, SR109AD01 (#) - f/b 02 or 11, f/b S, L. or H, may be f/b additional suffixes (%) - f/b 030 or 021, f/b S, L or H, may be f/b additional suffixes (&) - f/b 02 or 11, may be f/b additional suffixes (@) - f/b 030 or 021, may be f/b additional suffixes Note - Models are followed by any combination of alpha numeric suffixes. [+a] - [+a] - x = 1, 2 or 3 Last Updated on Questions? Print this page Terms of Use Page Top 2014 UL LLC When the UL Leaf Mark is on the product, or when the word "Environment" is included in the UL Mark, please search the UL Environment database for additional information regarding this product's certification. The appearance of a company's name or product in this database does not in itself assure that products so identified have been manufactured under UL's Follow-Up Service. Only those products bearing the UL Mark should be considered to be Certified and covered under UL's Follow-Up Service. Always look for the Mark on the product. UL permits the reproduction of the material contained in the Online Certification Directory subject to the following conditions: 1. The Guide Information, Assemblies, Constructions, Designs, Systems, and/or Certifications (files) must be presented in their entirety and in a non-misleading manner, without any manipulation of the data (or drawings). 2. The statement "Reprinted from the Online Certifications Directory with permission from UL" must appear adjacent to the extracted material. In addition, the reprinted material must include a copyright notice in the following format: " 2014 UL LLC".

12 NRNT7.E Switches, Industrial Control Certified for Canada Page 1 of 1 5/28/2014 Page Bottom NRNT7.E Switches, Industrial Control Certified for Canada Switches, Industrial Control Certified for Canada See General Information for Switches, Industrial Control Certified for Canada OMRON SCIENTIFIC TECHNOLOGIES INC 6550 DUMBARTON CIR FREMONT, CA USA E Investigated to CAN/CSA-C22.2 No. 14 Class 2 limit switches Model(s) HP2008 (#), HP2011 (%) Evaluation units, safety relays, open type Model(s) CM-S2, CM-S30, CM-S4 Limit switches Model(s) T4012 Series, T4016 Series, TL4019 Series, TL4024 Series Limit switches, Class 2 Model(s) T2008 (&), T2011 (@) Monitoring devices Model(s) EC-S Series Read heads, safety relays, open type Model(s) CM-S1PC3, CM-S1PC5, CM-S2PC3, CM-S2PC5, CM-S3PC3, CM-S3PC5 Safety relays, open type Model(s) SR10-1A01, SR10-1A02, SR10-1A03, SR101A01x [+a], SR102AM0x [+a], SR103AM0x [+a], SR104P01, SR104P02, SR104P03, SR104P0x [+a], SR105E0x [+a], SR106ED0x [+a], SR107AD01, SR108AD01, SR109AD01 (#) - f/b 02 or 11, f/b S, L. or H, may be f/b additional suffixes (%) - f/b 030 or 021, f/b S, L or H, may be f/b additional suffixes (&) - f/b 02 or 11, may be f/b additional suffixes (@) - f/b 030 or 021, may be f/b additional suffixes Note - Models are followed by any combination of alpha numeric suffixes. [+a] - [+a] - x = 1, 2 or 3 Last Updated on Questions? Print this page Terms of Use Page Top 2014 UL LLC When the UL Leaf Mark is on the product, or when the word "Environment" is included in the UL Mark, please search the UL Environment database for additional information regarding this product's certification. The appearance of a company's name or product in this database does not in itself assure that products so identified have been manufactured under UL's Follow-Up Service. Only those products bearing the UL Mark should be considered to be Certified and covered under UL's Follow-Up Service. Always look for the Mark on the product. UL permits the reproduction of the material contained in the Online Certification Directory subject to the following conditions: 1. The Guide Information, Assemblies, Constructions, Designs, Systems, and/or Certifications (files) must be presented in their entirety and in a non-misleading manner, without any manipulation of the data (or drawings). 2. The statement "Reprinted from the Online Certifications Directory with permission from UL" must appear adjacent to the extracted material. In addition, the reprinted material must include a copyright notice in the following format: " 2014 UL LLC".

13 OMRON AUTOMATION AND SAFETY THE AMERICAS HEADQUARTERS Chicago, IL USA OMRON CANADA, INC. HEAD OFFICE Toronto, ON, Canada OMRON ELECTRONICS DE MEXICO HEAD OFFICE México DF OMRON ELECTRONICS DE MEXICO SALES OFFICE Apodaca, N.L OMRON ARGENTINA SALES OFFICE Cono Sur OMRON CHILE SALES OFFICE Santiago OTHER OMRON LATIN AMERICA SALES OMRON ELETRÔNICA DO BRASIL LTDA HEAD OFFICE São Paulo, SP, Brasil OMRON EUROPE B.V. Wegalaan 67-69, NL-2132 JD, Hoofddorp, The Netherlands. +31 (0) Authorized Distributor: Automation Control Systems Machine Automation Controllers (MAC) Programmable Controllers (PLC) Operator interfaces (HMI) Distributed I/O Software Drives & Motion Controls Servo & AC Drives Motion Controllers & Encoders Temperature & Process Controllers Single and Multi-loop Controllers Sensors & Vision Proximity Sensors Photoelectric Sensors Fiber-Optic Sensors Amplified Photomicrosensors Measurement Sensors Ultrasonic Sensors Vision Sensors Industrial Components RFID/Code Readers Relays Pushbuttons & Indicators Limit and Basic Switches Timers Counters Metering Devices Power Supplies Safety Laser Scanners Safety Mats Edges and Bumpers Programmable Safety Controllers Light Curtains Safety Relays Safety Interlock Switches J79I-E-03 07/15 Note: Specifications are subject to change Omron Electronics LLC Printed in U.S.A. Printed on recycled paper.