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CHUBS' CHUBS' rsswna coNP•Nv Workers'Compensation ACEAMERl0ANm5URANCEO0MPANr ACE AMERICAN INSURANCE COMPANY EXTENSION OF INFORMATION Nw cwnFa cpps and Employers Liability rE AMERICAN 12185 Insurance Policy 12165 PAGE-CLASSIFICATION Information Page NUN R ❑Naw ❑X Raww1 ❑ itlLICYNW@ER ❑Now ®Rerrewal ❑Resume Llbal:WLq NunEv. 089038823 Symbol:WLR Nun-0 .C86038622 9POLICY Np. ❑IMINdual ❑Pannershlo PnEwIXW P0.11 ❑InoNduel PereNsship ❑Afeotlellgn Oc: WLR Number: 085224987 ❑X Corporation❑ Symbol:WLR N,m ..C83224951 ©Co n fon ❑.161 V 1 ❑Other Leger Entity CALIFORNIA 17988 E W Complete Item 4.of the Wonneaon P e Item 1. CORPORATION Inter4n0aslate ID No.:917261423 vmmlum saps Rale Named 17966 DIS0N AVE CfNkMbnf 0oda EallmelatlTWl Parf100 or Estlmaletl Ineurad CHESTERFIELD M063005 Federal Employer ID No.:453117900 No. R.mun.rfuen Ramurwnuon Premium MaliN Address L Employer's ID No.: AEGION CORP PITC CODE:1389 CLERICAL OFFICE EMPLOYEES NOC 8810 .28 For other named insured see EpInformation ernion of Page-Schedule of Named Insured,WC 99 99 99 A BRINDERSON For o0w uoflaces see Ep nsfon of Inlormaadn Page-Schedule of Other Workplaces,WC 99 9999 B Item 2. Policy Wod:Fmm 07-01.2019 To 07-01-2020 12:01 AM.,standard time at the named Insured's maillorl address. OIL OR GAS REFINING,DISTILLING OR COMMPRESSING '3719 1.64 UNITS-ERECTION OR REPAIR-ALL OPERATIONS Item 3A. Workan'Con,"mutbnlnfu.nos:Pan Ona of the pollcyapPlles to the Workan'Compensallan Law o/lha sales listed hare: MILLWRIGHT WORK NOC 3724 4.01 AZ.CA,MA PLUMBING-LOW WAGE 5183 5.63 PLUMBING-HIGH WAGE 5187 3.38 CONCRETE CONSTRUCTION NOC-INCL.FOUNDATIONS 5213 5.89 CONTRACTOR-EXECUTIVE SUPERVISOR 5606 .72 Item 38. Empicyan Liability Ineunnee:Pan Two of the policy applies to work In each state listed In Item 3A. ENGINEERS,INCLUDING OUTSIDE SALESPERSONS AND 8601 29 The limits of our liability under Part Two are: Bodily Injury by Accident$1,000,000 each aocdenl CLERICAL OFFICE EMPLOYEES Bodily Injury by Disease$1,000,000 policy limit SALESPERSONS-OUTSIDE 8742 36 CLERICAL OFFICE EMPLOYEES NOC Belo 28 Bedlly Injury by Disease S 1,000,000 sect emPbyee CORRPRO Ram 3C. Other Slabs Insurance: Pan Three of the policyapplies to the states,Nany.listed here: ALL STATES EXCEPT ELECTRICAL WIRING-LOW WAGE 5190 4.53 ND,OH,WA,WY, CONTRACTOR-EXECUTIVE SUPERVISOR 5606 .72 AND STATES DESIGNATED IN ITEM 3.A DRILLING-NOT GEOTHERMAL.OIL OR GAS,MINING. 62D4 9.65 QUARRYING Item 3D. This Policy Includes these endonemants and schedules: SALESPERSONS-OUTSIDE 87a2 .36 See schedule of Forms and Endorsements WC9999%D CLERICAL OFFICE EMPLOYEES NOC 8810 28 Item 4. The premium for his policy will be determined by our Manual of Rules,Gassifications,Rates and Rating Plans.Al Infomntion FYFE re0urred below b subject to venfirabon and charge by audit. BEE EXTENSION OF INFORMATION PAGE-CLASSIFICATIONS ANALYTICAL OR TESTING LABORATORIES 4511 .59 PAINTING-HIOH WAGE 5482 4.35 If indicated here,interim ad'uslments of premium will be madeMinimum Premium collect in AZ S CLERICAL OFFICE EMPLOYEES NOC 8910 .2B ❑Semi-Annually Quarterly Monthly Tole)Estimated=Id 1n Deposit Premium E RI PRODUCER NAME AND MAILING ADDRESS Minimum,Es9meled and Deposit Premiums are shown on the Information Page. Total Stale Premium LoCKTON COMPANIES LLC 3 CITY PLACE DRIVE SUITE 900 SAINT LOUIS MO 63141 THIS EXTENSION OF INFORMATION PAGE IS EFFECTIVE FOR THE POLICY PERIOD INDICATED ON THE POLICY PRODUCER CODE:271194 20-3354970 CGUINFORMATION PAGE UNLESS OTHERIMSE STATED. ISSUE DATE: 06/262019 (PAGE 1 CONTINUED) MARKETING OFFICE: CHICAGO BRANCH ISSUE DATE: 06/26/2019 WC%04 18(17005) Copyright 1987 Nafiunai Ccun it on Compensalicn Insurance WC 000001A(05/88) Copyright 1987 National Count on Compensation Insurance NSURED COPY INSURED COPY