LAKE ROOF AND RESTORATION LLC

MIDS MSTR
INVO FL
FICA 7.65% ESTIMATED PREMIUM $9,470.30
FUTA 0.60% ONE TIME / UP FRONT $1,000.00
ADMIN 3.00% TOTAL PAYROLL $83,000.00

Proposal Valid for 30 Days

12/21/2022

EFFECTIVE RATES
TOTAL BILL AFTER
STATE CODE DESCRIPTION WC RATE SUTA
RATE CUTOFFS

FL 5551 ROOFING-ALL KINDS & DRIVERS 11.41% 2.70% 25.36% 22.06%

State Assessment will be billed on premium for the following states:

CA 2.81%, PA 2.17%, MA 3.51%, MN 2.97%, NY 12.6%, NJ 5.48%, WV 4.0%.
New Account Rates
The following fees will be collected on the first invoice or when applicable:

One Time Fee

Teladoc Service (per employee/per month) $8.00

EPLI Per Employee/Per Pay Period $1.00
✓ Set-Up Fee $1,000.00
Per Claim Fee $1,000.00
Minimum Admin Fee Per Week $50.00
Minimum WC Fee Per Week $175.00

Full-time employees will be enrolled in Group Life Program with $20,000 benefit and Client will be billed $1.88 per week, per enrolled
employee. See benefits form for details.
Rates are based on the annual payroll amounts listed for each code. These rates are subject to change if amounts are not reached.

All rates/codes are contingent upon underwriting and approval by the Carrier.

Jose Saavedra (Dec 21, 2022 13:30 EST) 12/21/2022

Client Signature / Date john.rico printbyjohn.rico