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7RAVELERSJ'' <br />ONE TOWER SQUARE <br />HARTFORD CT 06183 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />EXTENSION OF INFO PAGE -SCHEDULE WC 00 00 01 ( A) <br />POLICY NUMBER: UB-OR3408OA-20-42-G <br />INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 072 003 <br />INSURED'S NAME:THE FRIDA CINEMA <br />PREMIUM BASIS <br />ESTIMATED <br />TOTAL ANNUAL <br />CLASSIFICATION CODE REMUNERATION <br />LOCATION 001 <br />FEIN 270950151 ENTITY CD 001 00 <br />THE FRIDA CINEMA <br />305 E 4TH ST <br />STE 100 <br />SANTA ANA , CA 92701 <br />NAILS: 531120 <br />THEATERS -MOTION PICTURE -ALL 9155 198884.00 <br />EMPLOYEES <br />DATE OF ISSUE:05-11-20 OW SCHEDULEN <br />13579-CA <br />RATES ESTIMATED <br />PER $100 OF ANNUAL <br />REMUNERATION PREMIUM <br />1 .89 3759 <br />Risk Manegnnent DMsimt <br />��/R'enEvrE� &{AP,P,IRIO�V/m BYE: <br />FAFhGvi1 R. Y � <br />Risk Management Analyst <br />