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<br />WORKERS CO"',rJENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> <br />Insured Name: KEEFE MCCULLOUGH & CO LLP <br /> <br />Policy Number: 001-WC10A-39871 <br />Agency Name: 320, Plastridge/Delray Beach <br /> <br />PREMIUM CALCULATION <br /> <br />Extension of Information Page WC 00 00 01 A Item 4: FLORIDA <br /> <br />Estimated <br />Remuneration <br /> <br />Classification <br /> <br />Code <br />8803 <br />8810 <br /> <br />Rate <br /> <br />AUDIT, ACCT, COMP SYS PRG-TRVL <br />CLERICAL NO DUTIES OUT OF OFC <br /> <br />2,310,761 <br />$4 <br /> <br />$.18 <br />$.26 <br /> <br />Premium <br /> <br />$4,159 <br />$0 <br /> <br />Manual Premium <br /> <br />$4,159 <br /> <br />Premium Subject to Experience Modification ................ <br /> <br />$4,159 <br /> <br />Experience Modification Factor ............................ <br /> <br />Standard Premium .......................................... <br /> <br />0.95 <br />$3,951 <br /> <br />Plus: Expense Constant .................................... <br /> <br />$200 <br /> <br />Plus: Terrorism ........................................... <br /> <br />Estimated Annual Premium .................................. <br /> <br />$462 <br />$4,613 <br /> <br />we 00 00 01 A <br />Copyright 1987 National Council on Compensation Insurance <br /> <br />EZ0102, 2196 Page 2 <br />