LIBERTY NORTHWEST INSURANCE CORPORATION - 21733 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY ACCOUNT EXECUTIVE: DAVID LAUCHNOR 0046 / New INFORMATION PAGE Status: CORPORATION FEIN: 810455233 Policy No. WC4-1NC-013684-011 Risk Id No. 250270135 TD/CD: 93 / 8 SFXlI: NO 1 1. The Insured: JORE CORPORATION Mailing Address: 45000 HWY 93 S RONAN, MT 59864 Other workplaces not shown above: 2. The policy period is from 7/01/2001 to 7/01/2002 12:01 a.m. standard time at the address of the insured as stated above. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MONTANA 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: Bodily Injury by Accident $100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except Ohio, North Dakota, Washington, West Virginia, Wyoming 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All Information shown on attached extension schedule is subject to verification and change by audit. Expense Constant: $ Included Reporting Frequency: Monthly Deposit Premium: $ 60,000.O0 Minimum Premium: $ 750 Total Estimated Annual Premium: $ 260,787 Endorsements: (See Extension of Information Page)