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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 99 06 07C (Ed 9-14) <br />Short Rate Table <br />Extened <br />Number of <br />Days <br />Percent of <br />Full Policy <br />Premium <br />Extened <br />Number of <br />Days <br />Percent of <br />Full Policy <br />Premium <br />Ertened <br />Number of <br />Days <br />Percent of <br />Full Policy <br />Premium <br />1 <br />...... <br />5% <br />95-98 <br />...... <br />37% <br />219-223 <br />...... <br />69% <br />2 <br />...... <br />6% <br />99-102 <br />...... <br />38% <br />224-228 <br />...... <br />70% <br />34 <br />...... <br />7% <br />103-105 <br />...... <br />39% <br />229-232 <br />...... <br />71% <br />5-6 <br />...... <br />8% <br />106109 <br />...... <br />40% <br />233-237 <br />...... <br />72% <br />7-8 <br />...... <br />9% <br />110-113 <br />...... <br />41% <br />238-241 <br />...... <br />73% <br />9-10 <br />...... <br />10% <br />114-116 <br />...... <br />42% <br />242-246 <br />Is mos.) <br />74% <br />11-12 <br />...... <br />11% <br />117-120 <br />...... <br />43% <br />247-250 <br />...... <br />75% <br />13-14 <br />...... <br />12% <br />121.124 <br />(4 mos,) <br />44% <br />251-255 <br />...... <br />76% <br />15-16 <br />...... <br />13 % <br />125.127 <br />...... <br />45% <br />256-260 <br />...... <br />77% <br />17-18 <br />...... <br />14% <br />128-131 <br />....-. <br />46% <br />261-264 <br />...... <br />78% <br />19-20 <br />...... <br />15% <br />132-135 <br />...... <br />47% <br />265-269 <br />...... <br />79% <br />21-22 <br />...... <br />16% <br />136-138 <br />...... <br />48% <br />270-273 <br />(9 mos.) <br />80% <br />23-25 <br />...... <br />17% <br />139-142 <br />...... <br />49% <br />274-278 <br />...... <br />81% <br />26-29 <br />...... <br />18% <br />143-146 <br />...... <br />50% <br />279-282 <br />...... <br />82% <br />30-32 <br />(1 mo.) <br />19% <br />147-149 <br />...... <br />51% <br />283-287 <br />...--. <br />83% <br />33-36 <br />...... <br />20% <br />150-153 <br />(5 mos.) <br />52 % <br />288-291 <br />...... <br />84% <br />37-40 <br />...... <br />21% <br />154-156 <br />...... <br />53% <br />292-296 <br />...... <br />85% <br />41-43 <br />...... <br />22% <br />157-160 <br />...... <br />54% <br />297-301 <br />....., <br />86% <br />44-47 <br />...... <br />23% <br />161.164 <br />...... <br />55% <br />302-305 <br />If mos.) <br />87% <br />48-51 <br />...... <br />24% <br />165-167 <br />...... <br />56% <br />306-310 <br />...... <br />88% <br />52-54 <br />...... <br />25% <br />168-171 <br />...... <br />57% <br />311-314 <br />...... <br />89% <br />55-58 <br />...... <br />26% <br />172-175 <br />...... <br />58% <br />315-319 <br />...... <br />90% <br />59-62 <br />(2 mos.) <br />27% <br />176-178 <br />...... <br />59 % <br />321-323 <br />...... <br />91 % <br />63-65 <br />...... <br />28 % <br />179-182 <br />(6 mos.) <br />60% <br />324-328 <br />...... <br />92 % <br />66-69 <br />...... <br />29% <br />183-187 <br />...... <br />61% <br />329-332 <br />...... <br />93 % <br />70-73 <br />...... <br />30% <br />188-191 <br />...... <br />62% <br />333-337 <br />(11 mos.) <br />94°% <br />74-76 <br />...... <br />31% <br />192-196 <br />...... <br />63% <br />338-342 <br />...... <br />95% <br />77-80 <br />...... <br />32% <br />197-200 <br />...... <br />64% <br />343-346 <br />...... <br />96 % <br />81-83 <br />...... <br />33% <br />201-205 <br />...... <br />65 % <br />347-351 <br />...... <br />97% <br />84-87 <br />....,. <br />34% <br />206-209 <br />...... <br />66% <br />352-355 <br />...... <br />98% <br />88-91 <br />(3 mos.) <br />35% <br />210-214 <br />(7 mos.) <br />67% <br />356-360 <br />...... <br />99% <br />92-94 <br />...... <br />36% <br />215-218 <br />...... <br />68% <br />361-365 <br />(12 mos.) <br />100% <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise staled. <br />(The Information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) <br />Endorsement Effective: 09/01/2019 <br />Insured: Houston & Harris, PCS, Inc. <br />Insurance Company: Cypress Insurance Company <br />WC 99 06 07C <br />(Ed 9-14) <br />Policy No.: HOWC013672 <br />Endorsement No.: <br />REVIEWEDF&dPMOVED <br />By Risk MANACEMENT Division <br />Jul 21 2020 <br />Page 2 of 2 <br />h Nl t- VILLARE <br />