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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 $100 of <br />PremiumNo.Remuneration Remuneration <br />Estimated <br />Policy Number: <br />Named Insured: <br />Agent: <br />WORKERS' COMPENSATION AND EMPLOYERS <br />LIABILITY INSURANCE POLICY <br />EIG 5927483 00 <br />PROGRESSIVE SOLUTIONS INC <br />ADP - PITTSBURGH - SBS 0033005 <br />EMPLOYERS PREFERRED INS. CO. <br />P.O. BOX 539003 <br />HENDERSON, NV 89053-9003 <br />A Stock Company <br />West Virginia <br />Rating Period: 04/01/2025 through 04/01/2026 <br />Site 00002 <br />8810 COMPUTER-SYSTEM DESIGNERS OR PROGRAMMERS- 191,000 0.080000 153.00 <br />EXCLUSIVELY OFFICE <br />$ 153.00Site 00002 Total <br />Total of Sites for Rating Period $ 153.00 <br />Rating Period Total $ 153.00 <br />Rating Period: 04/01/2025 through 04/01/2026 <br />9812 INCREASED COVERAGE II 153 0.014000 2.00 <br />9848 BALANCE TO MIN PREM-COVERAGE II 147.00 <br />9740 TERRORISM PREMIUM 191,000 0.010000 19.00 <br />9741 CATASTROPHE PREMIUM 191,000 0.020000 38.00 <br />0939 REGULATORY SURCHARGE 210 0.050000 11.00 <br />0936 FIRE AND CASUALTY SURCHARGE 149 0.005500 1.00 <br />Rating Period Total $ 218.00 <br />State Total $ 371.00 <br />Policy Total $ 1,078.00 <br />WC990630 (5/98 Ed.) <br />INSURED COPY06/10/2025Issued Date <br />Page 4 of 6 <br />Docusign Envelope ID: 2EA41CCF-A2B2-47D6-84CA-2A61682545FC