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<br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY <br />EXTENSION OF INFORMATION PAGE <br />ITEM 4. CONTINUED <br /> <br />CLASSIFICATION OF OPERATIONS <br />FL-9 Intrastate 1.0. 91103249 <br />LOC. 1 <br />Employees: 161 <br />NAICS: 921190 <br />Total Payroll: 10,226,000 <br />Sunny Isles Beach, (Miami-Dade) FL <br />33160 <br /> <br />f'rom 10/01/2009 <br /> <br />To 10/01/2010 <br /> <br />~US co: ALL OTHER EMPLOYEES & <br />Drivers <br /> <br />POLICE OFFICERS & Drivers <br /> <br />~LERICAL OFFICE EMPLOYEES NOC <br /> <br />~TTORNEY - ALL EMPLOYEES & <br />2lerical, Messengers, Drivers <br /> <br />~uildings - Operation: By owner, <br />essee or real estate management <br />~irm: all other employees <br /> <br />PARK NOC - ALL EMPLOYEES & Drivers <br /> <br />~TREET CLEANING & Drivers <br /> <br />~UNICIPAL, TOWNSHIP, COUNTY OR <br />pTATE EMPLOYEE NOC <br /> <br />f\R Adjustment <br /> <br />~enefits Deductible <br />Limit: 2,500 <br />Factor: 0.069000 <br /> <br />~mployer Safety Premium Credit <br /> <br />Drug-Free Workplace Credit <br />~otal After Credits <br /> <br />~xperience Modification <br />Final <br /> <br />STANDARD PREMIUM <br /> <br />~dvance Discount <br /> <br />'Jormal Premium <br />we 00 00 alA <br /> <br />CODE <br />NO. <br /> <br />POLICY NO. FMIT #0820 <br />PAGE NO. 1 <br /> <br />Estimated Total <br />Annual <br />Remuneration <br /> <br />Rates Per <br />$100 of <br />Remun- <br />eration <br /> <br />7382 271,000 6.00 <br /> <br />7720 3,545,000 3.63 <br /> <br />8810 2,870,000 0.28 <br /> <br />8820 277,000 0.22 <br /> <br />9015 879,000 4.16 <br /> <br />9102 1,402,000 4.20 <br />9402 50,000 7.07 <br />9410 932,000 2.84 <br /> <br />9664 <br /> <br />9765 <br /> <br />9841 <br /> <br />9898 <br /> <br />0063 <br /> <br />1.078 <br /> <br />0.020 <br /> <br />0.050 <br /> <br />0.810 <br /> <br />Estimated Annual Premiums <br /> <br />Subject to <br />Modification <br /> <br />All Other <br /> <br />16,260 <br /> <br />128,684 <br /> <br />8,036 <br /> <br />609 <br /> <br />36,566 <br /> <br />58,884 <br /> <br />3,535 <br /> <br />26,469 <br /> <br />21,765 <br /> <br />-20,756 <br /> <br />-5,601 <br /> <br />-13,723 <br /> <br />260,728 <br />-49,538 <br /> <br />211,190 <br /> <br />-18,555 <br /> <br />192,635 <br /> <br />08/06/09 <br />