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EMPLOYERSO <br />America's snlatiburiess insurance seocWsO <br />State <br />Class <br />Code <br />Loc <br />Class Description <br />Payroll <br />Rate <br />Estimated <br />Annual <br />Premium <br />CA <br />9101 <br />1 <br />COLLEGES OR SCHOOLS--PRIVATE--NOT <br />AUTOMOBILE SCHOOLS --ALL EMPLOYEES <br />OTHER THAN PROFESSORS, TEACHERS <br />OR ACADEMIC PROFESSIONAL <br />EMPLOYEES --INCLUDING CAFETERIAS <br />$0 <br />9.06 <br />($0) <br />SubTotal <br />$739 <br />CA <br />0900 <br />EXPENSE CONSTANT <br />$220 <br />CA <br />0936 <br />STATE W.C. FRAUD ASSESSMENT <br />$992 <br />0.001675 <br />$2 <br />CA <br />0935 <br />STATE W.C. ADMINISTRATIVE ASSESSMENT <br />$992 <br />0.003128 <br />$3 <br />CA <br />0937 <br />CA INSURANCE GUARANTY <br />$992 <br />0.02 <br />$20 <br />CA <br />0938 <br />CA UNINSURED EMPLOYERS FUND <br />$992 <br />0.000721 <br />$1 <br />CA <br />0939 <br />CA SUBSEQUENT INJURY FUND <br />$992 <br />0.001335 <br />$1 <br />CA <br />0940 <br />OSHF ASSESSMENT <br />$992 <br />0.002305 <br />$2 <br />CA <br />0943 <br />LABOR ENFORCEMENT & COMPLIANCE <br />$992 <br />0.001918 <br />$2 <br />CA <br />9741 <br />CATASTROPHE PREMIUM <br />$48,000 <br />0.04 <br />$19 <br />CA <br />9740 <br />TERRORISM PREMIUM <br />$48,000 <br />0.03 <br />$14 <br />SuloTotal <br />$284 <br />Total For State <br />$1,023 <br />Total For Policy <br />$1,023 <br />Minimum Premium <br />$750 <br />If during the policy term or at final audit, the Zip Code for any California location is determined to be other than <br />the corresponding Zip Code upon which premium was originally calculated, the premium will be subject to adjustment to <br />reflect exposures in the actual Zip Code. <br />Coverage for acts of terrorism is included in your policy. You are hereby notified that under the Terrorism Risk Insurance <br />Act, as amended in 2015, the definition of act of terrorism has changed. As defined in Section 102(1) of the Act: The <br />term "act of terrorism" means any act or acts that are certified by the Secretary of the Treasury -in consultation with <br />the Secretary of Homeland Security, and the Attorney General of the United States -to be an act of terrorism; to be a <br />violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the <br />United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States <br />mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population <br />of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Under <br />your coverage, any losses resulting from certified acts of terrorism may be partially reimbursed by the United States p,��,,�r�X� <br />Y/ " <br />Quotation for Workers` Compensation and Employers Liability Insurance Page 3 5bg <br />