IMPORTANT NOTICE TO WORKERS'COMPENSATION POLICYHOLDERS
The Workers' Compensation and Employers' Liability Insurance Policy has been prepared so as to incorporate byreference the manual provisions governing the computation of premium for this form of insurance. The following
summary of these provisions will acquaint you with the manner in which the premium for your workers' compensation
insurance is determined. This is informatory only and does not affect the insurance afforded by your policy

I BASIS OF PREMIUM
The basis of premium is the entire remuneration, whether in money or a substitute for money, for services
rendered by an employee.
The insured shall maintain records of the information necessary for premium computation on the basis stated on thepolicy Information Page.
The entire remuneration shall be used as the basis of premium and shall include commissions, bonuses, extra
wages for all overtime work, wages for holidays, vacations or sickness periods and payment to employees made on
any basis other than that of time actually engaged in work, including but not limited to piece work, incentive plans ofprofit sharing arrangements. Remuneration shall not include contributions made by the employer to a group insurance
or pension plan or special rewards for individual inventions or discoveries.
Whenever employees are recompensed in whole or in part by the value of rent or housing, or by store
certificates, merchandise, credits, or any other substitute for money, such form of payment shall be considered asremuneration.

II BOARD OR LODGING
Where board or lodging constitutes part of the employee's earnings and the values of such items to be usedin the determination of compensation benefits for any industry have been established by a State or Federal workers'
compensation authority, such values shall be included with the actual wages as remuneration. When the values havenot been so established, then minimum authorized values shall be included with wages to represent the monetary
value of board or lodging.

III EXTRA REMUNERATION EARNED FOR OVERTIME
1. "Overtime" shall mean those hours worked for which there is an increase in the rate of pay,(a) for work in any day or in any week in excess of the number of hours normally worked, but in any event forhours worked in excess of eight hours in any day or forty hours in any week, or(b) for work performed on Saturdays, Sundays or holidays. Provided, however, that in the case of guaranteed
wage agreements under which the employee receives a guaranteed wage for actually working any number ofhours up to a specified number of hours per week, "Overtime" shall include only those hours worked in excess
of such specified number.
2. If the employer's books and records are maintained so as to show separately, by employee and by class of work,(a) the extra remuneration earned for overtime in excess of the remuneration which would have been earned
for such overtime had the regular rate of pay applied, or1
TMA-519 ("B)

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IMPORTANT NOTICE TO WORKERS'COMPENSATION POLICYHOLDERS(b) the total remuneration for overtime for those hours worked at increased rates of pay, the remuneration
upon which the premium for the policy is based shall exclude respectively,(i) all of the remuneration in (a) above, or(ii) one-third of the remuneration shown in (b) or where double time is paid for overtime and theremuneration therefore is shown separately, one-half of the remuneration at double time.
Overtime remuneration does not include extra pay for swing or graveyard shifts: for working certain hours on the clock;or incentive or bonus pay figured on volume without regard to hours worked. Not applicable in Delaware, Pennsylvania
or Utah. These provisions do not apply to stevedoring operations.

IV PAYROLL LIMITATION
Payroll limitation applies to the remuneration of executive officers and, in some instances, to the remunerationof athletic teams and musicians and entertainers in theatres, restaurants, clubs and hotels. Consult with your agent
on these exceptions.

V CONTRACTORS
You may be responsible for injuries, including death resulting therefrom, sustained by employees ofcontractors per- forming work for you unless the contractors provide workers’ compensation insurance for theiremployees. It is therefore, necessary that each contractor furnish you with a certificate of insurance to demonstrate
his compliance with the workers' compensation law. This certificate must be exhibited to the company auditor whenyour books are audited. Should you fail to do so, you will be charged for the contractors insurance. The contract priceshall, for premium purposes, be considered as the remuneration if the actual remuneration of the contractor’s
employees cannot be ascertained. You may also be liable to the contractor himself, if he is an individual and youragreement with him permits you to control his activities. It is, therefore, incumbent upon you to establish by evidence
satisfactory to the company, that the contractor is independent and entirely free of your control or it may be necessaryto charge premium as though he was your employee.

VI GRATUITIESIn Pennsylvania, in employments in which employees customarily receive not less than one-third of theirremuneration in tips or gratuities not paid by the employer, such tips or gratuities shall be added to the wages actually
received subject to a minimum rate of $2.00 per day. ,VII EXECUTIVE OFFICERS, CO-PARTNERS AND INDIVIDUAL EMPLOYERS
If executive officers or co-partners are included, the entire remuneration of each shall be assigned without
division to the classification which is applicable to the actual operations in which such executive officer or copartneris primarily engaged, provided, however, that the entire remuneration of each executive officer or copartner who
performs such duties are ordinarily undertaken by a superintendent, foreman or workman, or whose duties include
direct charge of the actual performance of any operations of the risk, shall be assigned without division to the highest
rated classification which is applicable to any such duties undertaken by such executive officer or co-partner for any
part of his time, subject to the respective maximum and minimum remuneration prescribed for the states for which
coverage is provided.
TMA-519 ("B)

Printed in U.S.A

TMA is committed to the highest customer trust. We exist to deliver ANSHIN (safety,security and peace of mind) to our customers by providing the highest quality services.