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EXTENSION OF INFORMATION PAGE <br />CLASSIFICATION OF OPERATIONS <br />Premium Basis Rate Per <br />AnnualCode <br />Classification Description <br />Total Est. Annual $100 of <br />PremiumNo.Remuneration Remuneration <br />Estimated <br />Policy Number: <br />Named Insured: <br />Agent: <br />WORKERS' COMPENSATION AND EMPLOYERS <br />LIABILITY INSURANCE POLICY <br />EIG 5927483 00 <br />PROGRESSIVE SOLUTIONS INC <br />ADP - PITTSBURGH - SBS 0033005 <br />EMPLOYERS PREFERRED INS. CO. <br />P.O. BOX 539003 <br />HENDERSON, NV 89053-9003 <br />A Stock Company <br />Tennessee <br />Rating Period: 04/01/2025 through 04/01/2026 <br />Site 00003 <br />8810 CLERICAL OFFICE EMPLOYEES NOC 98,000 0.060000 59.00 <br />$ 59.00Site 00003 Total <br />Total of Sites for Rating Period $ 59.00 <br />Rating Period Total $ 59.00 <br />Rating Period: 04/01/2025 through 04/01/2026 <br />9812 INCREASED COVERAGE II 59 0.014000 1.00 <br />9887 SCHEDULE CREDIT 60 0.220000 -13.00 <br />9740 TERRORISM PREMIUM 98,000 0.010000 10.00 <br />9741 CATASTROPHE PREMIUM 98,000 0.010000 10.00 <br />Rating Period Total $ 8.00 <br />State Total $ 67.00 <br />WC990630 (5/98 Ed.) <br />INSURED COPY06/10/2025Issued Date <br />Page 3 of 6 <br />Docusign Envelope ID: 2EA41CCF-A2B2-47D6-84CA-2A61682545FC