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HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT <br />IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING <br />IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. <br />HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OR ADDRESS SHOULD <br />BE CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR, PLEASE TELL US. <br />IMPORTANT THIS IS NOT A BILL CONTINUOUS POLICY 9048876-21 <br />SEND NO MONEY UNLESS STATEMENT IS ENCLOSED <br />THE RATING PERIOD BEGINS AND ENDS AT 12:01AM RATING PERIOD 7-01-21 TO 7-01-22 <br />PACIFIC STANDARD TIME <br />INTERIM BILLING RATES WILL BE USED ON PAYROLL REPORTS. THEY TAKE INTO ACCOUNT <br />RATING PLAN CREDITS (OR DEBITS) WHICH WILL APPLY AT FINAL BILLING AND AN <br />ESTIMATE OF YOUR PREMIUM DISCOUNT AS DETAILED BELOW. <br />RATING PLAN CREDITS (DEBITS) EFFECTIVE FROM 07-01-21 TO 07-01-22 <br />RATING PLAN MODIFIER <br />ESTIMATED PREMIUM DISCOUNT MODIFIER <br />0.81893 <br />n_Ang45 <br />COMPOSITE FACTOR APPLIED TO BASE RATES TO DERIVE <br />INTERIM BILLING RATES 0.73904 <br />* PREMIUM DISCOUNT SCHEDULE EFFECTIVE FROM 07-01-21 TO 07-01-22 <br />ESTIMATED MODIFIED PREMIUM IS DISCOUNTED ACCORDING TO THE FOLLOWING SCHEDULE: <br />FIRST ABOVE <br />$5,000 $5,000 <br />0.0% 11.3% <br />THE ESTIMATED PREMIUM DISCOUNT IS BASED ON AN ESTIMATE OF YOUR PAYROLL. ACTUAL <br />PREMIUM DISCOUNT APPLIED AT FINAL BILLING WILL BE BASED ON THE ACTUAL PAYROLL <br />REPORTED ON YOUR POLICY AND SUBJECT TO AUDIT. <br />:OUNITEoRRMItGNEDREAND tl ISSUED AT SAN FRANCJSCOOVER PLEASE) JUNE 25, 2021 F <br />�oRaN <br />} z <br />a <br />Risk MmWmerdDMsian <br />REVIEWED & APPROVED BY: <br />p R. vj&wd <br />Risk Management Analyst <br />