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-- -- - A01k - <br />TRAVELERSJ' <br />ONE TOWER SQUARE <br />HARTFORD CT 06183 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 04 04 22 (00) <br />POLICY NUMBER: UH-OR3408OA-20-42-0 <br />Days In <br />Policy <br />Period <br />Short Rate <br />Percentages <br />Factors to Apply to <br />Earned Premium for <br />Period PolicyIn Effect <br />Days In <br />Policy <br />Period <br />Short Rate <br />Percentages <br />Factors to Apply to <br />Earned Premium for <br />Period PolicyIn Effect <br />Days In <br />Policy <br />Period <br />Short Rate <br />Percentages <br />Factors to Apply to <br />E arned Premium for <br />Period Policy In Effect <br />136 <br />48% <br />1.2882 <br />181 <br />60% <br />1.2099 <br />226 <br />70% <br />1.1305 <br />137 <br />48 <br />1.2788 <br />182 <br />60 <br />1.2033 <br />227 <br />70 <br />1.1255 <br />138 <br />48 <br />1.2696 <br />183 <br />61 <br />1.2167 <br />228 <br />70 <br />1.1206 <br />139 <br />49 <br />1.2867 <br />184 <br />61 <br />1.2101 <br />229 <br />71 <br />1.1317 <br />140 <br />49 <br />1.2775 <br />185 <br />61 <br />1.2035 <br />230 <br />71 <br />1-.1267 <br />141 <br />49 <br />1.2684 <br />186 <br />61 <br />1.1970 <br />231 <br />71 <br />1.1219 <br />142 <br />49 <br />1.2595 <br />187 <br />61 <br />1.1906 <br />232 <br />71 <br />1.1170 <br />143 <br />50 <br />1.2762 <br />188 <br />62 <br />1.2037 <br />233 <br />72 <br />1.1279 <br />144 <br />50 <br />1.2674 - <br />189 <br />62 <br />1.1974 <br />234 <br />72 <br />1.1231 <br />145 <br />50 <br />1.2586 <br />190 <br />62 <br />1.1910 <br />235 <br />72 <br />1.1183 <br />146 <br />50 <br />1.2500 <br />191 <br />62 <br />1.1848 <br />236 <br />72 <br />1.1136 <br />147 <br />51 <br />1.2663 <br />192 <br />63 <br />1.1977 <br />237 <br />72 <br />1.1089 <br />148 <br />51 <br />1.2578 <br />193 <br />63 <br />1.1914 <br />238 <br />73 <br />1.1195 <br />149 <br />51 <br />1.2493 <br />194 <br />63 <br />1.1853 <br />239 <br />73 <br />1.1149 <br />150 <br />52 <br />1.2653 <br />195 <br />63 <br />1.1792 <br />240 <br />73 <br />1.1102 <br />151 <br />52 <br />1.2569 <br />196 <br />63 <br />1.1732 <br />241 <br />73 <br />1.1056 <br />152 <br />52 <br />1.2487 <br />197 <br />64 <br />1.1858 <br />242 <br />74 <br />1.1161 <br />153 <br />52 <br />1.2405 <br />198 <br />64 <br />1.1798 <br />243 <br />74 <br />1.1115 <br />154 <br />53 <br />1.2562 <br />199 <br />64 <br />1.1739 <br />244 <br />74 <br />1.1070 <br />155 <br />53 <br />1.2481 <br />200 <br />64 <br />1.1680 <br />245 <br />74 <br />1.1025 <br />166 <br />53 <br />1.2401 <br />201 <br />65 <br />1.1804 <br />246 <br />74 <br />1.0980 <br />157 <br />54 <br />1.2554 <br />202 <br />65 <br />1.1745 <br />247 <br />75 <br />1.1083 <br />158 <br />54 <br />1.2475 <br />203 <br />65 <br />1.1687 <br />248 <br />75 <br />1.1038 <br />159 <br />54 <br />1.2396 <br />204 <br />65 <br />1.1630 <br />249 <br />75 <br />1.0994 <br />160 <br />54 <br />1.2319 <br />205 <br />65 <br />1.1573 <br />250 <br />75 <br />1.0950 <br />161 <br />55 <br />1.2469 <br />206 <br />66 <br />1.1694 <br />251 <br />76 <br />1.1052 <br />162 <br />55 <br />1.2392 <br />207 <br />66 <br />1.1638 <br />252 <br />76 <br />1.1008 <br />163 <br />55 <br />1.2316 <br />208 <br />66 <br />1.1582 <br />253 <br />76 <br />1.0964 <br />164 <br />55 <br />1.2241 <br />209 <br />66 <br />1.1526 <br />254 <br />76 <br />1.0921 <br />165 <br />56 <br />1.2388 <br />210 <br />67 <br />1.1645 <br />255 <br />76 <br />1.0878 <br />166 <br />56 <br />1.2313 <br />211 <br />67 <br />1.1590 <br />256 <br />77 <br />1.0979 <br />167 <br />56 <br />1.2240 <br />212 <br />67 <br />1.1535 <br />257 <br />77 <br />1.0936 <br />168 <br />57 <br />1.2384 <br />213 <br />67 <br />1.1481 <br />258 <br />77 <br />1.0893 <br />169 <br />57 <br />1.2311 <br />214 <br />67 <br />1.1428 <br />259 <br />77 <br />1.0651 <br />170 <br />57 <br />1.2238 <br />215 <br />68 <br />1.1544 <br />260 <br />77 <br />1.0810 <br />171 <br />57 <br />1.2167 <br />216 <br />68 <br />1.1491 <br />261 <br />78 <br />1.0908 <br />172 <br />58 <br />1.2308 <br />217 <br />68 <br />1.1438 <br />262 <br />78 <br />1.0866 <br />173 <br />58 <br />1.2237 <br />218 <br />68 <br />1.1385 <br />263 <br />78 <br />1.0825 <br />174 <br />58 <br />1.2167 <br />219 <br />69 <br />1.1500 <br />264 <br />78 <br />1.0784 <br />175 <br />58 <br />1.2097 <br />220 <br />69 <br />1.1448 <br />265 <br />79 <br />1.0881 <br />176 <br />59 <br />1.2236 <br />221 <br />69 <br />1.1396 <br />266 <br />79 <br />1.0840 <br />177 <br />59 <br />1.2167 <br />222 <br />69 <br />1.1345 <br />267 <br />79 <br />1.0800 <br />178 <br />59 <br />1.2098 <br />223 <br />69 <br />1.1294 <br />268 <br />79 <br />1.0759 <br />179 <br />60 <br />1.2235 <br />224 <br />70 <br />1A406 <br />269 <br />79 <br />1.0719 <br />180 <br />60 <br />1.2167 <br />225 <br />70 <br />1.1356 <br />270 <br />80 <br />1.0815 <br />© 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved <br />DATE OF ISSUE: 05-11-20 ST ASSIGN: <br />��++ Rtek Managenent Dhdaian <br />pRENEWED&DA.P'PIRO�V}EDBY. <br />t 18�1� �: ii f M4fYM�Q R,. N+,KRAfR.G <br />�- hisk Management Analyst <br />