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SCHEDULE OF OPERATIONS <br />This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is <br />indicated below: <br />INSURER: SENTINEL INSURANCE COMPANY LTD. <br />Company Code: A <br />Policy Number: 59 WEC AC9055 Schedule Number: 01-04-11 <br />Effective Date: 07/03/20 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Location Address of operations covered by this schedule: <br />BAY SPROUTS LLC <br />480 N ARROYO BLVD <br />PASADENA CA 91103 <br />FEIN: 46-2577161 <br />NAICS: 722110 <br />SIC: 5812 NO. OF EMPL: 15 <br />4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating <br />Plans. All information required below is subject to verification and change by audit. <br />Premium Basis <br />Classifications Total Estimated Rates Per Estimated <br />Code Number and Annual $100 of Annual <br />Description Remuneration Remuneration Premium <br />8078 <br />BEVERAGE PREPARATION SHOPS - NOT BARS OR <br />TAVERNS <br />Total State Summary <br />Total Class Premium <br />CA Territorial Differential <br />Waiver of Subrogation <br />Experience modifier <br />Schedule Rating Factor <br />Total Estimated Annual Standard Premium <br />Premium discount <br />Extended Broad Form Coverage <br />Terrorism Risk Insurance Program Reauthorization Act <br />Disclosure Endorsement <br />CA User Fund <br />CA Fraud <br />CA Uninsured Employers Benefit Trust Fund <br />CA Subsequent Injuries Benefit Trust Fund Assessments <br />CA Occupational Safety & Health Fund <br />CA Labor Enforcement & Compliance Fund <br />Total Estimated Annual Premium <br />Countersigned by <br />Form WC 99 00 05 (1) Printed in U.S.A. <br />Process Date: 05/25/20 <br />873,800.00 <br />3.830000 0 <br />33,467 <br />1.361200 <br />12,090 <br />0.020000 <br />669 <br />1.140000 <br />6,472 <br />0.850000 <br />-7,905 <br />44,793 <br />0.033000 <br />-1,478 <br />1.500000 <br />790 <br />0.020000 <br />175 <br />1.704000 <br />755 <br />0.334900 <br />148 <br />0.127400 <br />56 <br />0.482900 <br />214 <br />0.391800 <br />173 <br />0.381300 <br />169 <br />45,795 <br />^ RAMmWmentDMsian <br />Aw F <br />REVIEWED & APPROVED BY.- <br />i vmwd <br />Policy E Wsk Pjanagement Analpt <br />