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CLASSIFICATION AND PREMIUM <br />LOCATION <br />CLASSIFICATION <br />CODE <br />PREMIUM <br />RATE <br />ADVANCE <br />PREMIUM <br />NUMBER <br />NO. <br />BASE <br />Prem/ <br />Prod/Comp <br />Prem/ <br />Prod/Comp <br />Ops <br />Ops <br />Ops <br />Ops <br />43215 <br />UNITS <br />$200.00 <br />$0.00 <br />State Tax Or Other (if applicable) $0.00 <br />TOTAL PREMIUM (SUBJECT TO AUDIT) $200.00 <br />PREMIUM SHOWN IS PAYABLE; At Inception $ <br />At Each Anniversary $ <br />(If policy period is more than one year and premium is paid in <br />annual installments) <br />AUDIT PERIOD (IF APPLICABLE) <br />X Annually Semi -Annually Quartedy Monthly <br />NXT-0337 BM GL 0619 Includes copyrighted material of Insurance Services Office, Inc., <br />with its permission. <br />R",M=VmadDMs1mi <br />RE 1EWED&APPROVEDBr; <br />= T4"y J" <br />�. <br />® Risk Managemen[Malys[ <br />