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ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Uninsured Employee Benefits Trust Fund UEBTF Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $13.00 Ref# Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$4.00 Ref# Description Coverage Code Form No. Edition Date Schedule rate adjustment SRA Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$33.00 Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $160.00 Ref# Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$4.00 Ref# Description Coverage Code Form No. Edition Date Increased employer's liability INEL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $4.00 Ref# Description Coverage Code Form No. Edition Date OSHEF OSHEF Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $63.00 Ref# Description Coverage Code Form No. Edition Date Assessment Fund ASMNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $138.00 Ref# Description Coverage Code Form No. Edition Date Surcharges SURC Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $36.00 Ref# Description Coverage Code Form No. Edition Date Schedule rate adjustment SRA Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$86.00 Ref# Description Coverage Code Form No. Edition Date Merit Surcharge MERIT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$26.00 [EEV APPROVED Copyright 2001,AMS Services,Inc. By Cynthia Mora at 5:30 pm, Dec 02, 2024