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CLASSIFICATION AND PREMIUM <br />LOCATION CLASSIFICATION CODE PREMIUM RATE ADVANCE PREMIUM <br />NUMBER NO. BASE Prem/ Prod/Comp Prem/ Prod/Comp <br />Ops Ops Ops Ops <br />16902 GROSS_SALES 1,374.22 $110.78 <br />State Tax Or Other (if applicable) $0.00 <br />TOTAL PREMIUM (SUBJECT TO AUDIT) $1,485.00 <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 Quarterly Monthly <br />NXT-0337 BM GL 0619 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 3 <br />with its permission.