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IMPORTANT Policy Audit Information Dear Policyholder: This policy is issued with an estimated premium based upon information provided through your Producer. This premium is subject to adjustment at the end of the policy period. At that time, you may receive a request for information in the mail or a premium auditor may contact you to review the necessary records. The information developed is needed to determine the final earned premium for this policy. Record Maintenance In order to facilitate audit service, it is necessary to maintain proper records and have them available at the proper time. Based on the nature of your business, some of the following data will be necessary to complete the audit: 1. General Ledger, Financial Statements 2. Payroll Records, Time Books, State Unemployment Returns, FICA Returns, Individual Earnings Records -Monthly totals separated by type of work and overtime. 3. Cash Receipts, Sales Journal 4. Cash Disbursements Journal - Including subcontractors. casual labor and material costs. 5. Certificates of Insurance IMPORTANT COVERAGE NOTE: If you utilize subcontractors whose legal status is that of sole proprietor/partner, we may charge premium for these persons as provided under Part 5 of the policy contract even though certificates of insurance may exist. Please contact your producer if you have any questions regarding your Workers' Compensation coverage needs. Work in Other States Please advise your Producer if employees are hired for work in states other than those listed in Item 3. of your policy. This will enable your producer to consider your need for coverage in accordance with state laws. We appreciate the opportunity to serve you. If you have any questions about the enclosed policy or any insurance matters please contact your producer or your Company representative. WUNN7F00 RAMmsgemmtD1M1m 3"Y y REVIEWED&APPtR(a/v�mRY: 8 '7 ��FNGvI�t M1, MufF/i� Risk Management Analyst