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EMPLOYERS(D Workers'Compensation and Employers Liability <br /> Insurance Policy <br /> EMPLOYERS ASSURANCE CO. Policy Number From Policy Period <br /> A Stock Company EIG 1117026 16 10/15/2024 10/15/2025 <br /> 12:01A.M.Standard Time at the address of the <br /> Insured as stated herein <br /> Transaction <br /> AMENDED DECLARATIONS Effective: 10/15/2024 <br /> NCCI Carrier# 36870 WCIRB CARRIER# 00919 PRIOR POLICY NUMBER EIG1 1 1 70261 5 <br /> 1. Named Insured and Address Agent <br /> ARGO ENTERPRISES INC ADP- FLORHAM PARK-SERVICE 0033001 <br /> DBA UNISHIELD FLORHAM PARK-SERVICE <br /> 599 4TH STREET 1 ADP BLVD., M/S 625 <br /> SAN FERNANDO CA 91340 ROSELAND, NJ 07068 <br /> Telephone: 8005247024 <br /> Customer# Carrier# FEIN# Risk ID# Entity of Insured <br /> 36870 954718550 CORPORATION <br /> Additional Locations: <br /> 2. The Policy Period is from 10/15/2024 to 10/15/2025 12:01 a.m. Standard Time at the Insured's mailing address. <br /> 3. A. Workers Compensation Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states <br /> listed here: CA <br /> B. Employers Liability Insurance: Part TWO of the policy applies to work in each state listed in Item 3A. <br /> The limits of our liability under Part TWO are: <br /> Bodily Injury by Accident $ 1,000,000 each accident <br /> Bodily Injury by Disease $ 1,000,000 policy limit <br /> Bodily Injury by Disease $ 1,000,000 each employee <br /> C. Other States Insurance: Part THREE of the policy applies to the states, if any, listed here: <br /> All states except ND, OH, WA, WY and states listed in item 3.A. <br /> D. This policy includes these endorsements and schedules: See attached schedule. <br /> 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. <br /> All information required below is subject to verification and change by audit. <br /> SEE EXTENSION OF INFORMATION PAGE <br /> Minimum Premium $ 750 Expense Constant $ 160 <br /> Premium Discount $ <br /> Assessments and Taxes $ Total Estimated Annual Premium $ 8,656 <br /> ❑ This is a Three Year Fixed Rate Policy <br /> Premium Adjustment Period: ® Annual; ❑ Semiannual; ❑ Quarterly; ❑ Monthly <br /> Countersigned this Day of � <br /> Issued Date: 02/03/2025 Authorized Representative <br /> Issuing Office EMPLOYERS ASSURANCE CO. <br /> P.O. BOX 539003 <br /> HENDERSON, NV 89053-9003 <br /> Issued Date 02/03/2025 INSURED COPY <br /> WC990630 (5/98 Ed.) <br /> Page 1 of 3 <br />