WORKERS COMPENSATION Named Insured Carrier / A.M. Best Rating Jainish5169 Lodging LLC Employers / (A ) Policy Dates Policy Number PENDING Coverage Detail Description Limits Employers Liability: Each Accident $1,000,000 Employers Liability: Disease – Policy Limit $1,000,000 Employers Liability: Disease – Each Employee $1,000,000 Deductible - N/A Workers Compensation: Statutory Benefit GA Locations & Classifications Base St Code Description Payroll Rate Loc 1 357 Lee Street• Forest Park, GA 30297 GA 9052 Hotel, All Employees $120,000 1.66 Included / Excluded Individuals Name Title Included Excluded David Patel President/Owner • Additional Coverages Description Blanket Waiver of Subrogation 8/28/24 Page 14 of 19