Laserfiche WebLink
EXTENSION OF INFORMATION PAGE <br />CLASSIFICATION OF OPERATIONS <br />Premium Basis Rate Per <br />AnnualCode <br />Classification Description <br />Total Est. Annual $100 of <br />PremiumNo.Remuneration Remuneration <br />Estimated <br />Policy Number: <br />Named Insured: <br />Agent: <br />WORKERS' COMPENSATION AND EMPLOYERS <br />LIABILITY INSURANCE POLICY <br />EIG 5927483 00 <br />PROGRESSIVE SOLUTIONS INC <br />ADP - PITTSBURGH - SBS 0033005 <br />EMPLOYERS PREFERRED INS. CO. <br />P.O. BOX 539003 <br />HENDERSON, NV 89053-9003 <br />A Stock Company <br />California <br />Rating Period: 04/01/2025 through 04/01/2026 <br />Site 00001 <br />8859 COMPUTER PROGRAMMING OR SOFTWARE DEVELOPMENT-ALL 200,000 0.050000 100.00 <br />EMPLOYEES-INCLUDING CLERICAL OFFICE EMPLOYEES, CLERICAL <br />TELECOMMUTER EMPLOYEES AND OUTSIDE SALESPERSONS <br />THE ENTIRE REMUNERATION OF EACH EMPLOYEE SHALL BE <br />INCLUDED, SUBJECT TO A MAXIMUM OF $159,900 PER <br />YEAR. WHEN THE POLICY IS IN FORCE FOR LESS THAN A <br />12-MONTH PERIOD, THE MAXIMUM PAYROLL AMOUNT <br />SHALL BE PRORATED BASED UPON THE NUMBER <br />OF WEEKS IN THE POLICY PERIOD. <br />$ 100.00Site 00001 Total <br />Total of Sites for Rating Period $ 100.00 <br />Rating Period Total $ 100.00 <br />Rating Period: 04/01/2025 through 04/01/2026 <br />0930 WAIVER OF SUBROGATION 100 0.020000 250.00 <br />0900 EXPENSE CONSTANT 160.00 <br />0936 STATE W.C. FRAUD ASSESSMENT 610 0.004096 2.00 <br />0935 STATE W.C. ADMINISTRATIVE ASSESSMENT 610 0.012370 8.00 <br />0937 CA INSURANCE GUARANTY 610 <br />0938 CA UNINSURED EMPLOYERS FUND 610 0.000818 <br />0939 CA SUBSEQUENT INJURY FUND 610 0.030148 18.00 <br />0940 OSHF ASSESSMENT 610 0.001885 1.00 <br />0943 LABOR ENFORCEMENT & COMPLIANCE 610 0.001058 1.00 <br />9741 CATASTROPHE PREMIUM 200,000 0.020000 40.00 <br />9740 TERRORISM PREMIUM 200,000 0.030000 60.00 <br />Rating Period Total $ 540.00 <br />State Total $ 640.00 <br />WC990630 (5/98 Ed.) <br />INSURED COPY06/10/2025Issued Date <br />Page 2 of 6 <br />Docusign Envelope ID: 2EA41CCF-A2B2-47D6-84CA-2A61682545FC