Laserfiche WebLink
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: UE-OR340BOA-20-42-G <br />Days In <br />Policy <br />Period <br />Short Rate <br />Percentages <br />Factors to Apply to <br />Earned Premium for <br />Period Policy In Effect <br />Days In <br />Policy <br />Period <br />Short Rate <br />Percentages <br />Factors to Apply to <br />Earned Premium for <br />Period Policy In Effect <br />Days In <br />Policy <br />Period <br />Short Rate <br />Percentages <br />Factors to Apply to <br />Earned Premium for <br />Period Policy in Effect <br />271 <br />80 % <br />1.0775 <br />316 <br />90 % <br />1.0396 <br />361 <br />100% <br />1.0111 <br />272 <br />80 <br />1.0735 <br />317 <br />90 <br />1.0363 <br />362 <br />100 <br />1.0083 <br />273 <br />80 <br />1.0696 <br />318 <br />90 <br />1.0330 <br />363 <br />100 <br />1.0055 <br />274 <br />81 <br />1.0790 <br />319 <br />90 <br />1.0298 <br />364 <br />100 <br />1.0027 <br />275 <br />81 <br />1.0751 <br />320 <br />91 <br />1.0380 <br />365 <br />100 <br />1.0000 <br />276 <br />81 <br />1.0712 <br />321 <br />91 <br />1.0347 <br />277 <br />81 <br />1.0673 <br />322 <br />91 <br />1.0315 <br />278 <br />81 <br />1.0635 <br />323 <br />91 <br />1.0283 <br />279 <br />82 <br />1.0728 <br />324 <br />92 <br />1.0364 <br />280 <br />82 <br />1.0689 <br />325 <br />92 <br />1.0332 <br />281 <br />82 <br />1.0651 <br />326 <br />92 <br />1.0301 <br />282 <br />82 <br />1.0614 <br />327 <br />92 <br />1.0269 <br />283 <br />83 <br />1.0705 <br />328 <br />92 <br />1.0238 <br />284 <br />83 <br />1.0667 <br />329 <br />93 <br />1.0318 <br />285 <br />83 <br />1.0630 <br />330 <br />93 <br />1.0286 <br />286 <br />83 <br />1.0593 <br />331 <br />93 <br />1.0255 <br />287 <br />83 <br />1.0556 <br />332 <br />93 <br />1.0224 <br />288 <br />84 <br />1.0646 <br />333 <br />94 <br />1.0303 <br />289 <br />84 <br />1.0609 <br />334 <br />94 <br />1.0272 <br />290 <br />84 <br />1.0572 <br />336 <br />94 <br />1.0242 <br />291 <br />84 <br />1.0536 <br />336 <br />94 <br />1.0211 <br />292 <br />85 <br />1.0625 <br />337 <br />94 <br />1.0181 <br />293 <br />85 <br />1.0589 <br />338 <br />95 <br />1.0259 <br />294 <br />85 <br />1.0553 <br />339 <br />95 <br />1.0229 <br />295 <br />85 <br />1.0517 <br />340 <br />95 <br />1.0198 <br />296 <br />85 <br />1.0481 <br />341 <br />95 <br />1.0169 <br />297 <br />86 <br />1.0569 <br />342 <br />95 <br />1.0139 <br />298 <br />86 <br />1.0534 <br />343 <br />96 <br />1.0216 <br />299 <br />86 <br />1.0498 <br />344 <br />96 <br />1.0186 <br />300 <br />86 <br />1.0463 <br />345 <br />96 <br />1.0156 <br />301 <br />86 <br />1.0429 <br />346 <br />96 <br />1.0127 <br />302 <br />87 <br />1.0515 <br />347 <br />97 <br />1.0203 <br />303 <br />87 <br />1.0480 <br />348 <br />97 <br />1.0174 <br />304 <br />87 <br />1.0446 <br />349 <br />97 <br />1.0145 <br />305 <br />87 <br />1.0411 <br />350 <br />97 <br />1.0116 <br />306 <br />88 <br />1.0497 <br />351 <br />97 <br />1.0087 <br />307 <br />88 <br />1.0462 <br />352 <br />98 <br />1.0162 <br />308 <br />88 <br />1.0429 <br />353 <br />98 <br />1.0133 <br />309 <br />88 <br />1.0395 <br />354 <br />98 <br />1.0105 <br />310 <br />88 <br />1.0361 <br />355 <br />98 <br />1.0076 <br />311 <br />89 <br />1.0445 <br />356 <br />99 <br />1.0150 <br />312 <br />89 <br />1.0412 <br />357 <br />99 <br />1.0122 <br />313 <br />89 <br />1.0379 <br />358 <br />99 <br />1.0094 <br />314 <br />89 <br />1.0346 <br />359 <br />99 <br />1.0065 <br />315 <br />90 <br />1.0429 <br />360 <br />99 <br />1.0038 <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of <br />the policy.) <br />Endorsement Effective Policy No. Endorsement No. <br />Insured Premium $ <br />Insurance Company <br />Countersigned by <br />© 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved <br />DATE OF ISSUE: 05-11-20 STASSIGN: <br />ry� Risk Management Dlvislan <br />REVIEWED&APPROVEDfi r <br />R¢k Management Analyst <br />