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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: TRUMBULL INSURANCE COMPANY <br />Company Code: H <br />Policy Number: 59 WEC AC9055 Schedule Number: 01-05-06 <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 />1805 N 30TH ST <br />COLORADO SPRING CO 80904 <br />FEIN: 46-2577161 <br />NAICS: 722110 <br />SIC: 5812 NO. OF EMPL: 0 <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 />8006 362,500.00 1.930000 6,996 <br />STORE: COFFEE, TEA OR SPICE - RETAIL <br />Total State Summary <br />Total Class Premium <br />6,998 <br />Waiver of Subrogation <br />0.020000 <br />250 <br />Emp liab increased limits <br />0.003000 <br />21 <br />Schedule Rating Factor <br />0.900000 <br />-727 <br />Total Estimated Annual Standard Premium <br />6,542 <br />Premium discount <br />0.033000 <br />-216 <br />Extended Broad Form Coverage <br />3 <br />218 <br />Terrorism Risk Insurance Program Reauthorization Act <br />362,600.00 0.006000 <br />22 <br />Disclosure Endorsement <br />Catastrophe (other than certified acts of terrorism) <br />362,600.00 0.010000 <br />36 <br />Total Estimated Annual Premium <br />6,602 <br />Countersigned by <br />Form WC 99 00 05 (1) Printed in U.S.A. <br />Process Date: 05/25/20 <br />^ RAMmVmentDMsian <br />Aw F <br />REVIEWED & APPROVED BY.- <br />i v <br />Policy E Wsk Pjanagement Analpt <br />