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Berkshire Hathaway Direct Insurance Company Policy Number: CP140206066P2024 <br />A Stock Company <br />New Policy Renewal of <br />Premium (cont.): <br />CA <br />Classification Code Premium Basis: Rate per $100 <br />Total Estimated Annual Remuneration <br />Remuneration <br />Effective: 03-15-2024 - 03-15-2025 <br />RESTAURANTS OR TAVERNS --ALL 9079 $440,000 2.82 <br />EMPLOYEES-- INCLUDING MUSICIANS AND <br />ENTERTAINERS. (9079) <br />Total Est. Premium: 03-15-2024 - 03-15-2025 <br />Experience Modification <br />Minimum Premium: <br />Total Est. Standard Premium for CA <br />Estimated Annual <br />Premium <br />$12,408.00 <br />3,591.00 <br />$0.00 <br />Policy Totals <br />Manual Premium <br />$12,408.00 <br />Employers Liability <br />$25.00 <br />ELlncreased Limits <br />1000/1000/3000 <br />Subject Premium <br />$12,433.00 <br />Modified Premium <br />$12,433.00 <br />Standard Premium <br />$12,433.00 <br />Premium Discount <br />-$221.00 <br />Expense Constant CA: <br />$340.00 <br />Terrorism <br />$176.00 <br />Catastrophe <br />$88.00 <br />Total Est. Annual Premium <br />$12,816.00 <br />Revolving Fund <br />$315.00 <br />Subsequent Injury Fund <br />$204.00 <br />Insurance Guaranty Association <br />$0.00 <br />Uninsured Employers Fund <br />$19.00 <br />Occupational Safety and Health Fund <br />$93.00 <br />State Fraud <br />$53.00 <br />Labor Enforcement and Compliance Fund <br />$91.00 <br />Total Est. Cost for:CP140206066P2024 <br />$13,591.00 <br />Issuing Office: 1314 Douglas Street, Suite 1400, Omaha, NE 68102-1944 <br />WC 3P CA DEC A-220 2 <br />ATTY/AGR.2024.149/City Pub (2620 Broadway) (Page 34 of 36) <br />