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Insurance Certificates 2025/26 ITI Digital10/31/2025 The Hilb Group of Florida 5850 TG Lee Boulevard Suite 340 Orlando FL 32822 Jessenia Estrella jestrella@hilbgroup.com ITI Digital, LLC PO BOX 1785 Bradenton FL 34206 Underwriters at Lloyd's 15792 CL25103109012 A Professional liability Y Y ESM0134795199 11/03/2025 11/03/2026 5,000,000 10,000 1,000,000 5,000,000 1,000,000 Cyber & Tech E & O 5,000,000 A E&O/Cyber/Privacy & Network Security Y ESM0134795199 11/03/2025 11/03/2026 $5,000,000 City of La Quina listed as additional insured. City of La Quina 78495 Calle Tampico La Quina CA 92253 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 35 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 c. the reasons why you believe that this incident could give rise to a claim under this Policy; d. the identity of the potential claimant; and e. an indication as to the size of the claim that could result from this incident. In respect of INSURING CLAUSES 2, 3, 4, 5, 6 and 9, if you discover a cyber event you may only incur costs, other than costs incurred to respond to an extortion demand (including any ransom payment), without our prior written consent within the first 72 hours following the discovery and any third party costs incurred must be with a company forming part of the approved claims panel providers. All other costs may only be incurred with the prior written consent of the claims managers (which will not be unreasonably withheld). 2.Additional insureds We will indemnify any third party as an additional insured under this Policy, but only in respect of sums which they become legally obliged to pay (including liability for claimants' costs and expenses) as a result of a claim arising solely out of an act committed by you, provided that: a.you contracted in writing to indemnify the third party for the claim prior to it first being made against them; and b. had the claim been made against you, then you would be entitled to indemnity under this Policy. Before we indemnify any additional insured they must: a. prove to us that the claim arose solely out of an act committed by you; and b. fully comply with CONDITION 1 as if they were you. Where we indemnify a third party as an additional insured under this Policy, this Policy will be primary and non-contributory to the third party's own insurance, but only if you and the third party have entered into a contract that contains a provision requiring this. Where a third party is treated as an additional insured as a result of this Condition, any claim made by that third party against you will be treated by us as if they were a third party and not as an insured. 3.Agreement to pay claims (duty to defend) We have the right and duty to take control of and conduct in your name the investigation, settlement or defense of any claim. We will not have any duty to pay costs and expenses for any part of a claim that is not covered by this Policy. You may ask the claims managers to consider appointing your own lawyer to defend the claim on your behalf and the claims managers may grant your request if they consider your 36 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 lawyer is suitably qualified by experience, taking into account the subject matter of the claim, and the cost to provide a defense. We will endeavor to settle any claim through negotiation, mediation or some other form of alternative dispute resolution and will pay on your behalf the amount we agree with the claimant. If we cannot settle using these means, we will pay the amount which you are found liable to pay either in court or through arbitration proceedings, subject to the limit of liability. We will not settle any claim without your consent. If you refuse to provide your consent to a settlement recommended by us and elect to continue legal proceedings in connection with the claim, any further costs and expenses incurred will be paid by you and us on a proportional basis, with 50% payable by us and 50% payable by you. As a consequence of your refusal, our liability for the claim, excluding costs and expenses, will not be more than the amount for which the claim could have been settled. 4.Application warranty You agree that all statements made by you in the application form, including any renewal application form, and any supplemental materials you have supplied in support of the application for insurance, are your agreements and representations to us and the Policy is issued in reliance upon that information. The misrepresentation or non-disclosure of any matter by you or your agent will render this Policy null and void and relieve us from all liability under this Policy. 5.Calculation of business interruption losses Following an interruption to your business activities covered under INSURING CLAUSE 6 (SECTIONS C, D, E or F only), you must provide us with your calculation of the loss including: a. how the loss has been calculated and what assumptions have been made; and b. supporting documents including account statements, sales projections and invoices. 6.Cancellation This Policy may be canceled with 30 days written notice by either you or us. If you give us notice of cancellation, the return premium will be in proportion to the number of days that the Policy is in effect. However, if you have made a claim under this Policy there will be no return premium. If we give you notice of cancellation, the return premium will be in proportion to the number of days that the Policy is in effect. We also reserve the right of cancellation in the event that any amount due to us by you remains unpaid more than 60 days beyond the inception date. If we exercise this right of cancellation it will take effect from 14 days after the date the written notice of cancellation is issued. 37 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 The Policy Administration Fee will be deemed fully earned upon inception of the Policy. 7.Continuous cover In respect of INSURING CLAUSES 1 and 7 (SECTION G only), if during the period of a previous renewal of this Policy you neglected, through error or oversight only, to report to us an incident that might give rise to a claim, then provided you have maintained uninterrupted insurance of the same type with us since expiry of the previous renewal of this Policy, we will permit the incident to be reported to us under this Policy and we will indemnify you under this Policy in respect of any claim that arises out of the incident, provided: a. the indemnity will be subject to the applicable limit of liability of the previous renewal of this Policy under which the incident should have been reported to us or the applicable limit of liability, whichever is the lower; b.we may reduce the indemnity entitlement by the monetary equivalent of any prejudice which has been suffered as a result of the delayed notification; and c. the indemnity will be subject to all other terms and conditions of this Policy. We require you to provide full details of the incident, including but not limited to: a. the time, place and nature of the incident; b. the manner in which you first became aware of this incident; c. reasons why you believe that this incident could give rise to a claim; d. the identity of the potential claimant; and e. an indication as to the size of the claim that could result from this incident. For the avoidance of doubt, this Condition only applies to incidents that might give rise to a claim. 8.Cross liability and severability In respect of INSURING CLAUSE 7 only, where there is more than one entity insured under this Policy, and subject to the limit of liability, any claim made by one insured entity against another insured entity will be treated as if they are a third party and knowledge possessed by one insured entity will not be imputed to any other insured entity. 9.Dispute resolution All disputes or differences between you and us will be referred to mediation or arbitration and will take place in the country of registration of the company named as the insured in the Declarations page. In respect of any arbitration proceeding we will follow the applicable rules of the arbitration association in the country where the company stated as the insured in the Declarations page is registered, the rules of which are deemed incorporated into this Policy by reference to this Condition. Unless the applicable arbitration association rules state otherwise, a single 38 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 arbitrator will be appointed who will be mutually agreed between you and us. If you and we cannot agree on a suitable appointment then we will refer the appointment to the applicable arbitration association. Each party will bear its own fees and costs in connection with any mediation or arbitration proceeding but the fees and expenses of the arbitrator will be shared equally between you and us unless the arbitration award provides otherwise. Nothing in this Condition is intended to remove your rights under CONDITION 22. However, if a determination is made in any mediation or arbitration proceeding, CONDITION 22 is intended only as an aid to enforce this determination. 10.Fraudulent claims If it is determined by final adjudication, arbitral tribunal or written admission by you, that you notified us of any claim knowing it to be false or fraudulent in any way, we will have no responsibility to pay that claim, we may recover from you any sums paid in respect of that claim and we reserve the right to terminate this Policy from the date of the fraudulent act. If we exercise this right, we will not be liable to return any premium to you. However, this will not affect any non-fraudulent claim under this Policy which has been previously notified to us. 11.Extended reporting period An extended reporting period of 60 days following the expiry date will be automatically granted at no additional premium. This extended reporting period will cover, subject to all other terms, conditions and exclusions of this Policy: a. in respect of INSURING CLAUSES 1 and 7 (SECTION G only), any claim first made against you during the period of the policy and reported to us during this extended reporting period; b. in respect of INSURING CLAUSES 2, 3, 4, 5, 6 and 9, any cyber event, loss, operator error or system failure first discovered by you during the period of the policy and reported to us during this extended reporting period; and c. any circumstance that a senior executive officer became aware of during the period of the policy and reports to us during this extended reporting period. No claim will be accepted by us in this 60 day extended reporting period if you are entitled to indemnity under any other insurance, or would be entitled to indemnity under such insurance if its limit of liability was not exhausted. 12.Optional extended reporting period If we or you decline to renew or cancel this Policy then you will have the right to have issued an endorsement providing an optional extended reporting period for the duration stated in the Declarations page which will be effective from the cancellation or non-renewal date. 39 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 This optional extended reporting period will cover, subject to all other terms, conditions and exclusions of this Policy: a. in respect of INSURING CLAUSES 1 and 7 (SECTION G only), any claim first made against you and reported to us during this optional extended reporting period, provided that the claim arises out of any act, error or omission committed prior to the date of cancellation or non-renewal; and b. in respect of INSURING CLAUSES 2, 3, 4, 5, 6 and 9, any cyber event, loss, operator error or system failure first discovered by you during this optional extended reporting period, provided that the cyber event, loss, operator error or system failure first occurred during the period of the policy. If you would like to purchase the optional extended reporting period you must notify us and pay us the optional extended reporting period premium stated in the Declarations page within 30 days of cancellation or non-renewal. The right to the optional extended reporting period will not be available to you where cancellation or non-renewal by us is due to non-payment of the premium or your failure to pay any amounts in excess of the applicable limit of liability or within the amount of the applicable deductible as is required by this Policy in the payment of claims. At the renewal of this Policy, our quotation of different premium, deductible, limits of liability or changes in policy language will not constitute non-renewal by us. 13.Maintenance of employee automobile liability insurance It is a condition precedent to indemnity under INSURING CLAUSE 7 (SECTIONS H and I only) that all employees who operate an automobile in the course of your business activities will maintain in full force and effect for the period of the policy primary automobile liability insurance in an amount equal to, or greater than, the minimum primary automobile liability limits required in the state of registration of the automobile. If you make a claim under INSURING CLAUSE 7 (SECTIONS H and I only) and the employee has failed to meet these requirements then this Policy will only respond to provide excess coverage as though the requirements had been met, whereby you agree to pay all sums within and up to the required minimum limit. 14.Mergers and acquisitions If you acquire an entity during the period of the policy whose annual revenue does not exceed 20% of the company's annual revenue, as stated in its most recent annual financial statements, cover is automatically extended under this Policy to include the entity as a subsidiary. 40 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 If you acquire an entity during the period of the policy whose annual revenue exceeds 20% of the company's annual revenue, as stated in its most recent annual financial statements, cover is automatically extended under this Policy to include the entity as a subsidiary for 45 days. We will consider providing cover for the acquired entity after the period of 45 days if: a.you give us full details of the entity within 45 days of its acquisition; and b.you accept any amendment to the terms and conditions of this Policy and agree to pay any additional premium required by us. In the event you do not comply with a. and b. above, cover will automatically terminate for the entity 45 days after the date of its acquisition. If we agree to cover the acquired entity we will issue a mergers and acquisitions endorsement noting the acquired entity has cover under this Policy. If no endorsement is issued cover will automatically terminate for the entity 45 days after the date of its acquisition Cover for any acquired entity is only provided under this Policy for any act, error or omission committed or alleged to have been committed on or after the date of its acquisition. No cover will be automatically provided under this Policy for any acquired entity: a. whose business activities are materially different from your business activities; b. that has been the subject of any lawsuit, disciplinary action or regulatory investigation in the 3 year period prior to its acquisition; or c. that has experienced a cyber event in the 3 years period prior to its acquisition, if you have purchased INSURING CLAUSES 2, 3, 4, 5, 6 or 9 and the cyber event cost more than the highest deductible of INSURING CLAUSES 2, 3, 4, 5, 6 or 9. 15.Run-off cover In the event you consolidate, merge with or are acquired by another entity during the period of the policy, then cover under this Policy will continue to apply but only in respect of any act, error or omission committed or alleged to have been committed prior to the effective date of the consolidation, merger or acquisition. 16.New subsidiaries If you create an entity during the period of the policy cover is automatically extended under this Policy to include the entity as a subsidiary for 45 days. We will consider providing cover for the created entity after the period of 45 days if: a.you give us full details of the entity within 45 days of its creation; and b.you accept any amendment to the terms and conditions of this Policy and agree to pay any additional premium required by us. 41 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 In the event you do not comply with a. and b. above, cover will automatically terminate for the entity 45 days after the date of its creation. Cover for any created entity is only provided under this Policy for any act, error or omission committed or alleged to have been committed on or after the date of its creation. No cover will be automatically provided under this Policy for any created entity whose business activities are materially different from your business activities. 17.Our rights of recovery If we make any payment under this Policy and you have any right of recovery against a third party in respect of this payment, then we will maintain this right of recovery. You will do whatever is reasonably necessary to secure this right and will not do anything after the event which gave rise to the claim to prejudice this right. We will not exercise any rights of recovery against any employee, unless this is in respect of any fraudulent or dishonest acts or omissions as proven by final adjudication, arbitral tribunal or written admission by the employee. Any recoveries will be applied as follows: a. towards any recovery expenses incurred by us; b. then to us up to the amount of our payment under this Policy, including costs and expenses; c. then to you as recovery of your deductible. 18.Prior subsidiaries Should an entity cease to be a subsidiary after the inception date, cover in respect of the entity will continue as if it was still a subsidiary during the period of the policy, but only in respect of an act, error, omission or event occurring prior to the date that it ceased to be a subsidiary. 19.Process for paying privacy breach notification costs Any privacy breach notification transmitted by you or on your behalf must be done with our prior written consent. We will ensure that notification is compliant with any legal or regulatory requirements and contractual obligations and transmitted using the most cost effective means permissible under the governing law. No offer must be made for financial incentives, gifts, coupons, credits or services unless with our prior written consent which will only be provided if the offer is commensurate with the risk of harm. We will not be liable for any portion of the costs you incur under INSURING CLAUSE 3 (SECTION E only) that exceed the costs that you would have incurred had you gained our prior written consent. In the absence of our prior written consent we will only be liable to pay 42 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 you the equivalent cost of a notification made using the most cost effective means permissible under the governing law. If a senior executive officer becomes aware that a client has suffered a privacy breach, you and we agree that you will: a. endeavor as much as is reasonably practicable that any privacy breach notification transmitted by or on behalf of your client is compliant with any legal or regulatory requirements and contractual obligations and transmitted using the most cost effective means permissible under the governing law; and b. fully comply with CONDITION 1. 20.Waiver of subrogation Notwithstanding CONDITION 17, we agree to waive our rights of recovery against any third party if, prior to the claim or incident which you reasonably expected to give rise to a claim, you entered into a contract that contains a provision requiring you to do this. 21.Sanctions suspension It is a condition under this Policy that the provision of cover, the payment of any claim and the provision of any benefit will be suspended, to the extent that the provision of the cover, payment of the claim or provision of the benefit would expose us to any sanction, prohibition or restriction under the United Nations resolutions or the trade or economic sanctions, laws or regulations of Australia, Canada, the European Union, United Kingdom or United States of America. The suspension will continue until such time we would no longer be exposed to the sanction, prohibition or restriction. 22.Choice of law, jurisdiction and service of suit In the event of a dispute between you and us regarding this Policy, the dispute will be governed by the laws of the State of the United States of America shown as the choice of law stated in the Declarations page. We agree, at your request, to submit to the jurisdiction of a court of competent jurisdiction within the United States of America. Nothing in this Condition constitutes or should be understood to constitute a waiver of our rights to commence an action in any court of competent jurisdiction in the United States of America, to move an action to a United States District Court, or to seek a transfer of a case to another court as permitted by the laws of the United States of America or the laws of any State of the United States of America. It is further agreed that service of process in such suit may be made upon the representative stated in the Declarations page and that in any suit instituted against us, we will abide by the final decision of such court or of any appellate court in the event of an appeal. The representative stated in the Declarations page is authorized and directed to accept service of 43 ©1999-2025 CFC Underwriting Limited. All rights reserved. Technology v5.0 process on our behalf in any such suit and, at your request, to give a written undertaking to you that they will enter a general appearance on our behalf in the event such suit is instituted. Additionally, in accordance with the statute of any state, territory or district of the United States which makes such a provision, we hereby designate the Superintendent, Commissioner or Director of Insurance or other officer specified for that purpose in the statute, or his successor or successors in office, as our true and lawful attorney upon whom may be served any lawful process in any action, suit or proceeding instituted by you arising out of this Policy. The representative stated in the Declarations page is hereby designated as the person to whom the above mentioned officer is authorized to mail such process or a copy thereof. SEQUOIA INSURANCE COMPANY 17771 Cowan A venue Suite 100 /wine, CA 92614 WORKERS' COMPENSATION and EMPLOYERS' LIABILITY INSURANCE POLICY In Witness Whereof, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by our authorized representative. Stephen Ungar, Secretary Barry Dov Zyskind, President To obtain information, please contact your agent or Sequoia Insurance Company at 877- 528-7878. You may also write Sequoia Insurance Company Consumer Relations at: 800 Superior Avenue East, 21st Floor Cleveland, OH 44114 WC990000A 24/7 Toll Free Claim Reporting for All States (888)239-3909 WorkersCompClaimReportl@AmTrustgroup.com Information Required forAll Claims Reported www.amtrustfinancia[.com EE 1. Name of the insured and policy number 4. Description of accident or incident `� — 2. Name and contact information of injured worker 5. Name, phone, and/or email of person making the report V — 3. Date, time and place of accident 6. Any information on the injured workers lost time Early claim reporting is essential to a better claim outcome. Don't delay reporting if you do not have all the details. How do I help my injured worker find a doctor? • We offer an online physician search for all states, www.talispoint.com/amtrust/external • For California,www-lv.ta[ispoint.com/amtrust/campnn • For CO, GA, PA & TN, please refer to the panel provided by AmTrust via mail or email 9 How does my injured employee receive prescription medications related to the accident/injury? • Refer to the claims kitforyourstateatwww.ta[ispoint.com/amtrust/external for a First Fill card for your injured employee to use at the pharmacy to cover the cost of approved medication. 877.528.7878 1 www.amtrustfinancial.com This material is for informational purposes only and is not legal or business advice. NeitherAmTrust Financial Services, Inc. nor any of its subsidiaries or affiliates represents or warrants that the information contained herein is appropriate or suitable for any specific business or legal purpose. Readers seeking resolution of specific questions should consuItthe! r business and/or legal advisors. Coverages mayvary by location. Contact your local RSM for more information. F� AmTrust I N S U R A N C F MKT6310 06/23 © 2023, AmTrust Financial Services, Inc. Thank you for placing your Workers' Compensation Coverage with AmTrust. For your convenience, we now offer electronic versions of our Claims Kits. Please see the instructions and FAQs below for more information. Where's my claims kit? All the States' Claims Kits are online for insured to download which contains all the necessary WC notices. Visit the Talispoint Direct Link gFil at www.talispoint.com/amtrust/external[ • Click State Rules/Kits, choose corresponding state and open the PDF link to view and print. I have an injured worker, how do I find a doctor? We will provide completed Panel of Physicians for the 4 states that require a panel to be posted (CO,GA, PA & TN). We offer our online physician search forall other states. There are 3 ways to access this information: 1. Visit the Talispoint Direct Link at www.to[ispoint.com/amtrust/externa[ 2. California MPN: www.talispoint.com/amtrust/camp 3. Visit the AmTrust Financial Website at www.amtrustfinancial.com • Click Claims • Click Provider Directory or California MPN under"Find a Provider" • State specific laws for directing medical treatment are listed on the State Rules Tab • Search for physicians by Name, Address or Region Where are my posting notices? F-CO All states claim kits are available online, including applicable postings. There are 4 states (CO, CT, FL & MD) we cannot place online. For these states, we will mail additional posting notices to the main address on the policy. I have a question about my claims kit, posting notice, panel or accessing the website's physician searches, who do I contact? You may send an email to clientservices(@amtrustgroup.com. Please make sure to include your policy number along with your request. I have a question about a claim or injured worker, who do I contact? 111 Customer Service can direct you to the appropriate person. Please contact them at 888-239-3909. FA AmTrust 59 Maiden Lane, New York, NY10038 1 877.528.7878 1 www.amtrustfinancial.com F I N A N C I A L AmTrustlsAmTrust Financial Services, Inc., located at59 Maiden Lane, New York, NY 10038. Coverages are provided by its affiliated property and casualty insurance companies. Consult the applicable policy for specific terms, conditions, Ilmits and exclusions to coverage. For full legal disclaimer!nformation, including Texas and Wash! ngton writing companies, visit: www.amtrustfinancial.com/about-us/legal-disclaimer. M KT5948 02/22 © 2022, AmTrust Fin anclaI Services, Inc. ft AmTrust North America An AmTrust Financial Company October 31, 2024 Dear Policyholder, In an effort to continue to provide AmTrust customers with a variety of billing options, we have updated our fee structure to help customers meet payment due dates, ensure that valid and properly funded payments are submitted, and provide an incentive for paid -in -full options. Our updated fee structure is as follows: Fee Title Fee Amount Description Returned Payment Fee $25 A returned payment fee applied to any returned payment. Late Fee $20 Late fee applied if payment not received on or before payment due date. Installment Fee $15 A "paper" billing fee that is assessed for each mailed installment invoice. Excludes down payment and annual payment plans. Fee is billed at the account level. Reinstatement Fee $50 Fee applied upon reinstatement of a non-payment cancellation. EFT Fee $3 An "electronic" billing fee that is assessed for each ACH Direct Debit transaction. Fee is billed at the account level. *Fee amount may vary by state and program of business For policyholders who choose to pay their annual premium on installments, we plan to implement an installment fee, which will be displayed on your renewal invoice. Thank you for your attention to this fee structure change. If you have any questions, feel free to contact our Customer Service Department at 877.528.7878. We value you as a policyholder and appreciate the opportunity to serve you. Sincerely, AmTrust North America Customer Service Department 800 Superior Avenue E • 21st Floor • Cleveland, OH 44114 (p) 866.203.3037 • (� 800.487.9654 • www.amtrustnorthamerica.com Sequoia Insurance Company A Stock Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Ncci Code: 19755 Insured: ITI DIGITAL, LLC 130 Riviera Dunes Way #302 Palmetto, FL 34221 Other workplaces not shown above: See Extension of Information Page Producer: Morris & Templeton Insurance Agency P. O. Box 15088 Savannah, GA 31416 WC 99 00 01 B 1 of 5 INFORMATION PAGE Policy Number: QWC1409654 _Individual _Partnership Corporation or X LLC Federal Tax ID: 311476976 Risk Id: Renewal of: QWC1323854 2. The policy period is from 12/30/2024 to 12/30/2025 12:01 a.m. at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: Alabama, Georgia, Kentucky, Virginia B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: State Bodily Injury by Accident Bodily Injury by Disease Bodily Injury by Disease $500,000 each accident $500,000 policy limit $500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except ND, OH, WA, WY and State(s) Designated in Item 3.A D. This policy includes these endorsements and schedules: See Extension of Information Page 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. See Extension of Information Page TOTAL ESTIMATED ANNUAL PREMIUM 795 STATE ASSESSMENT 17 TOTAL ESTIMATED COST 812 Minimum Premium 500 Deposit Premium 812 Issue Date: 10/31/2024 Countersigned by: Authorized Representative Kentucky Premium Surcharge - Total Estimated Cost includes a surcharge as required by KRS 136.392 Sequoia Insurance Company WC 99 00 01 B 2 of 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: ITI DIGITAL, LLC Policy Number: QWC1409654 NAMED INSURED WORKPLACES: EXTENSION OF INFORMATION PAGE FOR ITEM #1 ITEM 1: NAMED INSURED and WORKPLACES ITI DIGITAL, LLC Location Number 1. 2 E Bryan St Savannah, GA 31401 Location Number 3. 3800 Barnard Dr Lexington, KY 40509 Fein: 311476976 Location Number 2. 7495 Pin Oak Circle Bristol, VA 24202 Location Number 4. 100 Du Rhu Dr Mobile, AL 36608 Sequoia Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Insured: ITI DIGITAL, LLC EXTENSION OF INFORMATION PAGE FOR ITEM #3.13 ITEM 3.13: ENDORSEMENT SCHEDULE WC 99 00 01 B 3 of 5 INFORMATION PAGE Policy Number: QWC1409654 State Form Number Description WC990001 B DECLARATIONS PAGE WC000000C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC000404 PENDING RATE CHANGE ENDORSEMENT WC000406 PREMIUM DISCOUNT ENDORSEMENT WC000414A NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT WC000419A PREMIUM DUE DATE ENDORSEMENT WC000421 F CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT WC000422C TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT WC000424 AUDIT NONCOMPLIANCE CHARGE ENDORSEMENT GA WC100601C GEORGIA CANCELLATION, NONRENEWAL, AND CHANGE ENDORSEMENT KY WC160305 KENTUCKY PART ONE WORKERS COMPENSATION INSURANCE ENDORSEMENT KY WC160601 KENTUCKY CANCELATION AND NONRENEWAL ENDORSEMENT KY WC160602 KENTUCKY NOTICE OF APPEAL RIGHTS ENDORSEMENT VA WC450602 VIRGINIA AMENDATORY ENDORSEMENT Sequoia Insurance Company WC 99 00 01 B 4 of 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: ITI DIGITAL, LLC Policy Number: QWC1409654 EXTENSION OF INFORMATION PAGE FOR ITEM #4 ITEM 4: SCHEDULE OF PREMIUMS # of Classifications Emps Code No. Premium Basis Total Estimated Annual Remuneration Rate Per $100 of Remun. Estimated Annual Premium Alabama Salespersons, Collectors or Messengers —Outside 0 8742 41,200 0.15 62 Manual Premium 62 Total Manual Premium 62 Premium for Increased Limits Part Two: 1.1% (500/500/500) 9807 1 Premium to Equal Increased Limits Minimum Charge 9848 99 Total Premium Subject To Experience Modification 162 Experience Modification (N/A) 9898 162 Terrorism 0.5% 9740 2 Catastrophe (other than Terrorism) 1 % 9741 4 Minimum Premium Adjustment 0990 0 Expense Constant 0900 0 Total AL Premium 168 Total AL Cost 168 Georgia Salespersons, Collectors or Messengers —Outside 0 8742 97,850 0.15 147 Computer System Designers or Programmers: Traveling 2 8803 0.03 Computer System Designers or Programmers: Exclusively Office 2 8810 150,414 0.08 120 Manual Premium 267 Total Manual Premium 267 Premium for Increased Limits Part Two: 0.8% (500/500/500) 9807 0 Total Premium Subject To Experience Modification 267 Experience Modification (N/A) 9898 267 Terrorism 0.6% 9740 15 Catastrophe (other than Terrorism) 1 % 9741 25 Minimum Premium Adjustment 0990 0 Expense Constant 0900 0 Total GA Premium 307 Total GA Cost 307 Kentucky Salespersons, Collectors or Messengers —Outside 1 8742 Manual Premium Total Manual Premium Premium for Increased Limits Part Two: 0.8% (500/500/500) 9807 Total Premium Subject To Experience Modification Experience Modification (N/A) 9898 Terrorism 0.6% 9740 Catastrophe (other than Terrorism) 1 % 9741 Minimum Premium Adjustment 0990 Expense Constant 0900 Total KY Premium All Employers Special Fund Assessment 6.53% 9999 Total KY Cost 37,874 0.14 53 53 53 0 53 53 2 4 0 200 259 17 276 Virginia Salespersons, Collectors or Messengers —Outside 1 8742 Manual Premium Total Manual Premium Premium for Increased Limits Part Two: 0.8% (500/500/500) 9807 Total Premium Subject To Experience Modification Experience Modification (N/A) 9898 Terrorism 1 % 9740 Catastrophe 0% 9741 Minimum Premium Adjustment 0990 Expense Constant 0900 Total VA Premium Total VA Cost TOTAL ESTIMATED ANNUAL PREMIUM STATE ASSESSMENT 66,950 0.08 54 54 54 0 54 54 7 0 0 0 61 61 795 17 TOTAL COST 812 Sequoia Insurance Company WC 99 00 01 B 5 of 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Insured: ITI DIGITAL, LLC Policy Number: QWC1409654 PAYMENT SCHEDULE Statement Payment Closing Date Due Date Description Amount Due 12/30/2024 Annual Premium Due $812.00 Total Cost $812.00 Printed: 10/31 /2024 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C (Ed. 1-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: GENERAL SECTION A. The Policy This policy includes at its effective date the Infor- mation Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Infor- mation Page) and us (the insurer named on the In- formation Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an em- ployer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any fed- eral occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the District of Columbia. E. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self -insured for such workplaces. PART ONE WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or ag- gravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily in- jury by disease must occur during the policy period. B. We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. C. We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to in- vestigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. reasonable expenses incurred at our request, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other 1 of 6 0 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC 00 00 00 C (Ed. 1-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G. Recovery From Others We have your rights, and the rights of persons enti- tled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have notice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our du- ties under this insurance after an injury occurs. 3. We are directly and primarily liable to any per- son entitled to the benefits payable by this in- surance. Those persons may enforce our duties; so may an agency authorized by law. Enforce- ment may be against us or against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance; b. special taxes, payments into security or oth- er special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your du- ties under this policy. PART TWO EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or inci- dental to your work in a state or territory listed in Item 3.A. of the Information Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or ag- gravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily in- jury by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by ac- cident or by disease must be brought in the United States of America, its territories or pos- sessions, or Canada. B. We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your employ- ees, provided the bodily injury is covered by this Employers Liability Insurance. The damages we will pay, where recovery is permit- ted by law, include damages: 1. For which you are liable to a third party by rea- son of a claim or suit against you by that third party to recover the damages claimed against 2 of 6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C (Ed. 1-15) such third party as a result of injury to your em- ployee; 2. For care and loss of services; and 3. For consequential bodily injury to a spouse, child, parent, brother or sister of the injured em- ployee; provided that these damages are the di- rect consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. Liability assumed under a contract. This exclu- sion does not apply to a warranty that your work will be done in a workmanlike manner; 2. Punitive or exemplary damages because of bodi- ly injury to an employee employed in violation of law; 3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive offic- ers; 4. Any obligation imposed by a workers compensa- tion, occupational disease, unemployment com- pensation, or disability benefits law, or any simi- lar law; 5. Bodily injury intentionally caused or aggravated by you; 6. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7. Damages arising out of coercion, criticism, de- motion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimina- tion against or termination of any employee, or any personnel practices, policies, acts or omis- sions; 8. Bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act (33 U.S.C. Sections 901 et seq.), the Nonap- propriated Fund Instrumentalities Act (5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C. Sections 1331 et seq.), the Defense Base Act (42 U.S.C. Sections 1651-1654), the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901- 944), any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; 3 of 6 9. Bodily injury to any person in work subject to the Federal Employers' Liability Act (45 U.S.C. Sec- tions 51 et seq.), any other federal laws obligat- ing an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10.Bodily injury to a master or member of the crew of any vessel, and does not cover punitive dam- ages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law; 11.Fines or penalties imposed for violation of federal or state law; and 12.Damages payable under the Migrant and Sea- sonal Agricultural Worker Protection Act (29 U.S.C. Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D. We Will Defend We have the right and duty to defend, at our ex- pense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceed- ings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. Reasonable expenses incurred at our request, but not loss of earnings; 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. Litigation costs taxed against you; 4. Interest on a judgment as required by law until we offer the amount due under this insurance; and 5. Expenses we incur. © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC000000C (Ed. 1-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other in- surance or self-insurance. Subject to any limits of li- ability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is ex- hausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G. Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.B. of the Information Page. They apply as explained below. 1. Bodily Injury by Accident. The limit shown for "bodily injury by accident —each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. Bodily Injury by Disease. The limit shown for "bodily injury by disease —policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by dis- ease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for "bodily injury by disease —each em- ployee" is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include dis- ease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liability un- der this insurance. H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insurance You will do everything necessary to protect those rights for us and to help us enforce them. I. Actions Against Us There will be no right of action against us under this insurance unless: 1. You have complied with all the terms of this poli- cy; and 2. The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to deter- mine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obliga- tions under this Part. PART THREE OTHER STATES INSURANCE A. How This Insurance Applies 1. This other states insurance applies only if one or more states are shown in Item 3.C. of the Infor- mation Page. 2. If you begin work in any one of those states after the effective date of this policy and are not in- sured or are not self -insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page. 3. We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. 4. If you have work on the effective date of this pol- icy in any state not listed in Item 3.A. of the In- formation Page, coverage will not be afforded for that state unless we are notified within thirty days. B. Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other ser- vices required by the workers compensation law. 2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. 3. Promptly give us all notices, demands and legal 4of6 © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 C (Ed. 1-15) papers related to the injury, claim, proceeding or suit. 4. Cooperate with us and assist us, as we may re- quest, in the investigation, settlement or defense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would in- terfere with our right to recover from others. 6. Do not voluntarily make payments, assume obli- gations or incur expenses, except at your own cost. PART FIVE PREMIUM A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifica- tions. We may change our manuals and apply the changes to this policy if authorized by law or a gov- ernmental agency regulating this insurance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifi- cations. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C. Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remu- neration is the most common premium basis. This premium basis includes payroll and all other remu- neration paid or payable during the policy period for the services of: 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged in work that could make us liable under Part One (Workers Com- pensation Insurance) of this policy. If you do not have payroll records for these persons, the con- tract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the em- ployers of these persons lawfully secured their workers compensation obligations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensa- tion law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premi- um basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the bal- ance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be de- termined in the following way unless our manuals provide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short -rate cancelation table and procedure. Final premium will not be less than the minimum premium. F. Records You will keep records of information needed to com- pute premium. You will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledg- ers, journals, registers, vouchers, contracts, tax re- ports, payroll and disbursement records, and pro- grams for storing and retrieving data. We may con- duct the audits during regular business hours during the policy period and within three years after the pol- icy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. 5 of 6 0 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WC000000C (Ed. 1-15) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY A. Inspection PART SIX CONDITIONS We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurabil- ity of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organiza- tions have the same rights we have under this provision. B. Long Term Policy If the policy period is longer than one year and six- teen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days af- ter your death, we will cover your legal representa- tive as insured. D. Cancelation 1. You may cancel this policy. You must mail or de- liver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy. We must mail or de- liver to you not less than ten days advance writ- ten notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancelation notice. 4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to com- ply with the law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. 6 of 6 0 Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY PENDING RATE CHANGE ENDORSEMENT WC 00 04 04 (Ed. 04-84) A rate change filing is being considered by the proper regulatory authority. The filing may result in rates different from the rates shown on the policy. If it does, we will issue an endorsement to show the new rates and their effective date. If only one state is shown in Item 3.A. of the Information Page, this endorsement applies to that state. If more than one state is shown there, this endorsement applies only in the state shown in the Schedule. Schedule State AL GA KY VA This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Policy No. QWC1409654 Endorsement No. 0 Insured ITI DIGITAL, LLC Premium $ 795 Insurance Company Sequoia Insurance Company Countersigned by WC 00 04 04 (Ed. 04-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 06 (Ed. 8-84) PREMIUM DISCOUNT ENDORSEMENT The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Items 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. Schedule 1. State Estimated Eligible Premium First Next Next $5,000 $100,000 $500,000 Balance Alabama 0% 10.9% 12.6% 14.4% $5,000 $100,000 $500,000 Balance Georgia 0% 10.9% 12.6% 14.4% $5,000 $100,000 $500,000 Balance Kentucky 0% 10.9% 12.6% 14.4% $5,000 $100,000 $500,000 Balance Virginia 0% 10.9% 12.6% 14.4% 2. Average Percentage Discount: 0% 3. Other policies: 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see the Premium Discount Endorsement attached to your policy number: This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Policy No. QWC1409654 Endorsement No. 0 Insured ITI DIGITAL, LLC Premium $ 795 Insurance Company Sequoia Insurance Company Countersigned by WC 00 04 06 (Ed. 8-84) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC000414A (Ed. 01-19) 90-DAY REPORTING REQUIREMENT —NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT You must report any change in ownership to us in writing within 90 days of the date of the change. Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity, and other changes provided for in the applicable experience rating plan. Experience rating is mandatory for all eligible insureds. The experience rating modification factor, if any, applicable to this policy, may change if there is a change in your ownership or in that of one or more of the entities eligible to be combined with you for experience rating purposes. Failure to report any change in ownership, regardless of whether the change is reported within 90 days of such change, may result in revision of the experience rating modification factor used to determine your premium. This reporting requirement applies regardless of whether an experience rating modification is currently applicable to this policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Policy No. QWC1409654 Endorsement No. 0 Insured ITI DIGITAL, LLC Premium $ 795 Insurance Company Sequoia Insurance Company Countersigned by WC 00 04 14 A (Ed. 01-19) © Copyright 2017 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 19 A (Ed. 08-2022) Part Five -Premium Amendatory Endorsement This endorsement amends Part Five -Premium of the policy as follows: Part Five -Premium, Section A. (Our Manuals) is replaced by the following provision: A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates and loss costs (as applicable), rating plans, forms, endorsements, and classifications, and such manuals are expressly incorporated by reference into, and apply to, this policy and any renewals (our manuals). As used in this policy and any renewals, our manuals means manuals that have been: 1.Developed in any format and filed by the state -designated workers compensation rating or advisory organization on our behalf with the appropriate state insurance regulatory authority; or 2.Developed in any format and filed by the respective state rating bureau on our behalf with the appropriate state insurance regulatory authority; or 3.Developed in any format and filed by us with the appropriate state insurance regulatory authority; and 4. For each or any of the three scenarios above, the manuals also must be approved for use by the appropriate state insurance regulatory authority, or as otherwise authorized by law as applicable. We may change our manuals and apply the changes to this policy and any renewals if such manual changes are approved for use by the appropriate state insurance regulatory authority, or as otherwise authorized by law as applicable. Part Five -Premium, Section D. (Premium Payments) is replaced by the following provision: D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the due date specified in the billing for the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Policy No. QWC1409654 Endorsement No. 0 Insured ITI DIGITAL, LLC Premium $ 795 Insurance Company Sequoia Insurance Company Countersigned by WC 00 04 19 A (Ed. 08-2022) © Copyright 2021 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 21 F (Ed. 08-2022 Countrywide, Ed. 07-2022 in Texas) Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement This endorsement is notification that we are charging premium to cover the losses that may occur in the event of a Catastrophe (Other Than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism). Coverage for such losses is subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement attached to this policy. For purposes of this endorsement, Catastrophe (Other Than Certified Acts of Terrorism) is defined as: A single event or peril resulting in a group of claims with aggregate workers compensation losses in excess of $50 million. This $50 million threshold applies per occurrence, across all states for which claims arise from a single event or peril. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium AL 0.010 $4.00 GA 0.010 $25.00 KY 0.010 $4.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Policy No. QWC1409654 Endorsement No. 0 Insured ITI DIGITAL, LLC Premium $ 795 Insurance Company Sequoia Insurance Company Countersigned by WC 00 04 21 F (Ed. 08-2022 Countrywide, Ed. 07-2022 in Texas) © Copyright 2021 National Council on Compensation Insurance, Inc. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 C (Ed. 01-21) TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2019. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2019. "Act Of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States, as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property, or infrastructure. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United c. States missions or certain air carriers or vessels. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United d. States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2021, and ending on December 31, 2027, an amount equal to 20% of our direct earned premiums during the immediately preceding calendar year. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. WC 00 04 22 C (Ed. 01-21) © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 C (Ed. 01-21) Schedule State Rate Premium AL 0.005 $2.00 GA 0.006 $15.00 KY 0.006 $2.00 VA 0.010 $7.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Policy No. QWC1409654 Endorsement No. 0 Insured ITI DIGITAL, LLC Premium $ 795 Insurance Company Sequoia Insurance Company Countersigned by WC 00 04 22 C (Ed. 01-21) © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 24 (Ed. 1-17) /d11C19zNkiwe] LTA l»/_1zN=N:/_ 0M=111:1z191O R-1:1►Vi1:1►II Part Five —Premium, Section G. (Audit) of the Workers Compensation and Employers Liability Insurance Policy is revised by adding the following: If you do not allow us to examine and audit all of your records that relate to this policy, and/or do not provide audit information as requested, we may apply an Audit Noncompliance Charge. The method for determining the Audit Noncompliance Charge by state, where applicable, is shown in the Schedule below. If you allow us to examine and audit all of your records after we have applied an Audit Noncompliance Charge, we will revise your premium in accordance with our manuals and Part 5—Premium, E. (Final Premium) of this policy. Failure to cooperate with this policy provision may result in the cancellation of your insurance coverage, as specified under the policy. Note: For coverage under state -approved workers compensation assigned risk plans, failure to cooperate with this policy provision may affect your eligibility for coverage. Schedule States(s) Estimated Annual Premium Maximum Audit Noncompliance Amount Charge Multiplier AL $162 2X GA $267 2X KY $53 2X VA $54 2X This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Policy No. QWC1409654 Endorsement No. 0 Insured ITI DIGITAL, LLC Premium $ 795 Insurance Company Sequoia Insurance Company Countersigned by WC 00 04 24 (Ed. 1-17) © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 10 06 01 C (Ed. 7-18) GEORGIA CANCELLATION, NONRENEWAL, AND CHANGE ENDORSEMENT This endorsement applies because Georgia is shown in Item 3.A. of the policy Information Page. Part Six —Conditions, Section D. (Cancellation) of the policy is replaced by the following: D. Cancellation, Nonrenewal, and Change You may cancel this policy. You must mail or deliver advance notice to us in writing, or deliver advance notice orally or electronically, stating when the cancellation is to take effect. We may require that you provide written, electronic, or other recorded verification of the request before the cancellation takes effect. The cancellation is subject to the following: a. If only your interest is affected, the effective date of cancellation will be the later of the date we receive notice from you or the date specified in the notice. b. If by statute, regulation, or contract this policy may not be cancelled unless notice is given to a governmental agency or other third party, we will mail or deliver at least 10 days' notice to you and the third party as soon as practical after receiving your request for cancellation. Our notice will state the effective date of cancellation, which will be the later of the following: 1)10 days from the date of mailing or delivering our notice, or 2) The effective date of cancellation stated in your notice to us. 2. We may cancel or nonrenew this policy. We must mail or deliver notice at least 10 days before the effective date of cancellation if this policy has been in effect less than 60 days or if we cancel for nonpayment of premium. If this policy has been in effect 60 or more days and we cancel for a reason other than nonpayment of premium, or if we nonrenew this policy, we must send a notice of cancellation or nonrenewal by certified mail, return receipt requested, to you at your last address of record at least 75 days before the effective date of cancellation or nonrenewal. 3. If we increase current policy premium by more than 15% (other than any increase in premium due to change in risk or exposure, including a change in experience rating modification or resulting from an audit of auditable coverages), we must deliver a notice of our action (including dollar amount of the increase in renewal premium more than 15%) to you, by first class mail, at your last address of record at least 45 days before the expiration date of this policy. 4. If we reduce the policy coverage, we must provide you with written notice at least 45 days before the effective date of the reduction in coverage. The notice will be delivered to you in person or by first class mail to your last address of record. A reduction in coverage made by us includes elimination of coverage, a decrease in scope or less coverage, or the addition of an exclusion. Requests made by you to change, reduce, or eliminate coverage are not considered reductions in coverage. 5. If you fail to submit to, or allow an audit for, the current or most recently expired policy term, we may, after two documented efforts to notify you and your agent of potential cancellation, send via certified mail or statutory overnight delivery, return receipt requested, written notice to you at least 10 days before the effective date of cancellation in lieu of the number of days' notice otherwise required by state law. However, we must not mail a cancellation notice within 20 days of the first documented effort to notify you of potential cancellation. 6. The policy period will end on the day and hour stated in the cancellation notice except as provided for above. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Insured ITI DIGITAL, LLC Insurance Company Sequoia Insurance Company WC100601C (Ed. 7-18) Policy No. QWC1409654 Endorsement No. Premium: $795 Countersigned by © Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 16 03 05 (Ed. 6-07) KENTUCKY PART ONE WORKERS COMPENSATION INSURANCE ENDORSEMENT This endorsement modifies the insurance policy to which it is attached and applies to the insurance provided by this policy because Kentucky is shown in Item 3.A. of the Information Page. F. 3. of Part One, Workers Compensation Insurance of the policy is replaced by the following: F. Payments You Must Make 3. you fail to comply with a health or safety law or regulation; provided that, however, we are responsible for payment of any amounts in excess of the benefits regularly provided under the workers compensation law of this state if an accident is caused in any degree by the intentional failure of the employer to comply with any specific statute or lawful administrative regulation made thereunder, communicated to the employer and relative to the installation or maintenance of safety appliances or methods as provided in KRS 342.165(1); or Except for any payments for which we are responsible as provided in Section F.3. above, if we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. © 2007 National Council on Compensation Insurance, Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 16 06 01 (Ed. 12-97) KENTUCKY CANCELATION AND NONRENEWAL ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Kentucky is shown in Item 3.A. of the Information Page. The Cancelation Condition of the policy is replaced by the following: Cancelation 1. You may cancel this policy. You will deliver or mail advance written notice to us, stating when the cancelation is to take effect. 2. We may cancel this policy. We will deliver or mail to you not less than 75 days advance written notice stating when the cancelation is to take effect and our reason or reasons for cancelation. If we cancel for nonpayment of premium or within 60 days of the date of issuance of the policy, we will deliver or mail this notice not less than 14 days prior to the effective date of cancelation. Proof of mailing of this notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. After coverage has been in effect more than 60 days or after the effective date of a renewal policy, we may not cancel the policy unless cancelation is based on one or more of the following reasons: a. nonpayment of premium; b. discovery of fraud or material misrepresentation made by you or with your knowledge in obtaining the policy, continuing the policy, or presenting a claim under the policy; c. discovery of willful or reckless acts or omissions on your part increasing any hazard originally insured; d. changes in conditions after the effective date of the policy or any renewal substantially increasing any hazard originally insured; e. a violation of any local fire, health, safety, building, or construction regulation or ordinance at any of your covered workplaces substantially increasing any hazard originally insured; f. our involuntary loss of reinsurance for the policy; g. a determination by the commissioner that the continuation of the policy would place us in violation of Kentucky insurance laws. Nonrenewal 1. We may elect not to renew the policy. We will deliver or mail to you not less than 75 days advance written notice stating our intention not to renew and our reason or reasons for nonrenewal. Proof of mailing of this notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 2. If we fail to provide the notice of nonrenewal as required, the policy will be deemed to be renewed for the ensuing policy period upon payment of the appropriate premium, and coverage will continue until you have accepted replacement coverage with another insurer, until you have agreed to the nonrenewal, or until the policy is canceled. 3. If we have delivered or mailed to you a renewal notice, bill, certificate, or policy not less than 30 days before the end of the current policy period clearly stating the amount and due date of the renewal premium charge, then the policy will terminate on the due date without further notice unless the renewal premium is received by us or our agent on or before the due date. If the policy terminates in this manner, we will deliver or mail to you within 15 days of termination at your mailing address shown in Item 1 of the Information Page a notice that the policy was not renewed and the date on which coverage ceased to exist. Proof of mailing of the renewal premium to us or our agent on or before the due date will constitute a presumption of receipt on or before the due date. 4. If we offer to renew the policy for a premium amount more than 25% greater than the premium amount for the current policy term for like coverage and like risks, we will deliver or mail to you and to your agent not less than 75 days advance written notice of the renewal premium amount. We may at our option, in order to comply with this requirement, extend the period of coverage of the current policy at the expiring premium. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 16 06 02 (Ed. 10-99) This endorsement applies only to the insurance provided by the policy because Kentucky is shown in Item 3.A. of the Information Page. NOTICE OF YOUR RIGHTS If you believe that the rates or the rating system under this policy have been incorrectly or improperly applied, you may request a review of the manner in which the rate or rating system has been applied. You must make your request in writing to us or the National Council on Compensation Insurance, Inc. (NCCI). We or NCCI has thirty (30) days to grant or reject your request for a review and to notify you in writing whether your request has been granted or rejected. If your request is granted, we or NCCI shall conduct the review within ninety (90) days of receiving your request. If your request is rejected or if you are dissatisfied with the results of the review, you may appeal to the commissioner for further review. You must make your appeal within thirty (30) days of receipt of the rejection or of the results of your review. Your appeal is to be sent to: Legal Division Department of Insurance P.O.Box 517 Frankfort, KY 40602 If you believe that the rates or the rating system under this policy have been incorrectly or improperly applied, you may request a review of the manner in which the rate or rating system has been applied. You must make your request in writing to us or the National Council on Compensation Insurance, Inc. (NCCI). We or NCCI has thirty (30) days to grant or reject your request for a review and to notify you in writing whether your request has been granted or rejected. If your request is granted, we or NCCI shall conduct the review within ninety (90) days of receiving your request. If your request is rejected or if you are dissatisfied with the results of the review, you may appeal to the commissioner for further review. You must make your appeal within thirty (30) days of receipt of the rejection or of the results of your review. Your appeal is to be sent to: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 45 06 02 (Ed. 7-93) VIRGINIA AMENDATORY ENDORSEMENT This endorsement applies only to the Virginia insurance provided by the policy because Virginia is shown in Item 3.A. of the Information Page. For Virginia insurance, Part Six D. (Conditions—Cancelation) is replaced by: 1. You may cancel this policy. You must mail or deliver advance written notice to us. You must provide written notice of your cancelation, including the date of and reasons for the cancelation, to the Workers Compensation Commission. 2. We may cancel this policy. We will provide you with 30 days notice of cancelation. We will provide the Workers Compensation Commission with immediate notice of such cancelation. This provision does not apply if you have obtained other insurance and that insurer has notified the Workers Compensation Commission that it is now providing your insurance. 3. In the event of cancelation by you or us, you must provide 30 days written notice of the cancelation to your covered employees. 4. We may nonrenew your policy. We will provide 30 days notice to you and to the Workers Compensation Commission of our decision to nonrenew. This provision does not apply if you have obtained other insurance and that insurer has notified the Workers Compensation Commission that it is now providing your insurance. 5. If you fail to pay the premium due on this policy, we may cancel the policy by providing 10 days notice to you and to the Workers Compensation Commission. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 12/30/2024 Insured ITI DIGITAL, LLC Insurance Company Sequoia Insurance Company WC 45 06 02 (Ed. 7-93) Policy No.QWC1409654 Countersigned by Endorsement No. Premium $795 © 1993 National Council on Compensation Insurance. Sequoia Insurance Company IMPORTANT NOTICE SMALL DEDUCTIBLE ELECTION FORM POLICY NUMBER POLICY PERIOD QWC1409654 FROM:12/30/2024 TO: 12/30/2025 INSURED ITI DIGITAL, LLC Alabama law permits an employer to purchase workers' compensation insurance with a deductible. The deductible is applicable to medical and indemnity benefits and applies to each claim. The deductibles available are as follows: DEDUCTIBLE AMOUNT EACH CLAIM $100 $200 $300 $400 $500 $1,000 $1,500 $2,000 n $2,500 You are not required to select a deductible. However, if you choose to exercise this option, you may choose only one deductible amount. It is to be understood that we will pay the deductible amount for you and that you must reimburse us for any deductible amounts paid. Non -reimbursement of the deductible(s) will result in cancellation of your policy. Please check the option you have elected and return this form to us as soon as possible. No, I do not want the deductible described in this Notice. nYes, I want the deductible checked above to apply to medical and indemnity benefits under the Alabama Workers' Compensation Law. I understand that the Company shall pay the deductible amount and be reimbursed by the employer shown above. If you fail to respond promptly to the Company, it will be construed to mean you have not elected the small deductible option. If you have any questions, please contact your agent or broker. INSURED'S SIGNATURE AND TITLE DATE Policyholder Notice AL-SDEF 01 (11/03) Sequoia Insurance Company POLICY NUMBER QWC1409654 INSURED ITI DIGITAL, LLC IMPORTANT NOTICE �9►yi/_1IaQ49191091 34=144*011Is] ki1;101N►►i POLICY PERIOD FROM: 12/30/2024 TO: 12/30/2025 Georgia law permits an employer to purchase workers' compensation insurance with a deductible. The deductible is applicable to medical and indemnity benefits and applies to each claim. The deductibles available are as follows: DEDUCTIBLE AMOUNT EACH CLAIM ❑ $100 a $1,000 ❑ $200 $1,500 ❑ $300 $2,000 ❑ $400 $2,500 n $500 You are not required to select a deductible. However, if you choose to exercise this option, you may choose only one deductible amount. It is to be understood that we will pay the deductible amount for you and that you must reimburse us for any deductible amounts paid. Non -reimbursement of the deductible(s) will result in cancellation of your policy. Please check the option you have elected and return this form to us as soon as possible. No, I do not want the deductible described in this Notice. Yes, I want the deductible checked above to apply to medical and indemnity benefits under the Georgia Workers' Compensation Law. I understand that the Company shall pay the deductible amount and be reimbursed by the employer shown above. If you fail to respond promptly to the Company, it will be construed to mean you have not elected the small deductible option. If you have any questions, please contact your agent or broker. INSURED'S SIGNATURE AND TITLE DATE Policyholder Notice GA-SDEF 01 (11/03)