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Argonaut Insurance Company <br />711 Broadway, San Antonio, TX 78215 <br />P.O. Box 469011, San Antonio, TX 78246 <br />WC000001A <br />NCCI CARRIER CODE NO. 14095 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />INFORMATION PAGE <br />1. The Insured: E . J. WARD INC <br />Mailing address:12621 SILICON DR STE 113 <br />San Antonio, TX 78249-3447 <br />Other workplaces not shown above: See Schedule <br />Policy No. WC 929268845524 <br />Renewal of: NEW <br />Individual <br />Partnership <br />X Corporation or <br />Federal Employers I.D.# See Schedule <br />Inter/Intrastate Risk I.D. # 917146896 <br />Other I.D. # <br />2. The policy period is from 0 9/0 1 / 2 025 12:01 a.m. to 0 9 / 01 / 2 02 6 12:01 a.m. standard time at the Insured's <br />mailing address. <br />3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states <br />listed here: CA, CO, CT, FL, MD, NJ, NY, PA, TN, VA, WI <br />B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of <br />our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident <br />Bodily Injury by Disease $ 1,000,000 policy limit <br />Bodily Injury by Disease $ 1,000,000 each employee <br />C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: <br />All states except states designated in Item 3.A. of the Information Page <br />and IL,ND,OH,TX,WA,WY <br />D. This policy includes these endorsements and schedules: See Schedule <br />4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. <br />All information required below is subject to verification and change by audit. <br />Premium Basis Rate Per <br />Code Total Estimated $100 of Estimated <br />Classification No. Annual Remuneration Remuneration Annual Premium <br />See Item 4. Extension WC 00 00 01A <br />Total Estimated Annual Premium and Surcharges $ <br />Deposit Premium $ 10,749 <br />Minimum Premium $ 826 (CA) 5191 <br />Premium Adjustment Period: Annual Countersigned by: <br />Servicing Office: 9208 — Chicago, IL (800) 422-9120 <br />Producer: TRIDENT INSURANCE SERVICES, LLC <br />711 Broadway <br />San Antonio, TX 78215 <br />Producer Code: 920A-DO8 <br />Expense Constant $ <br />11,258 <br />295 <br />Date: 09/11/2025 <br />Copyright 1987 National Council on Compensation Insurance. <br />