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<br />.. J"~,' 05 04 02: 57p <br /> <br />Di~oov~r~ Mu~~um <br /> <br />714 540-1932 <br /> <br />p.2 <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />F=UNO <br /> <br />HOME OFFICE <br />SAN FRANCISCO EFFECTIVE <br /> <br />All5FFECTIVE DATES ARE <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />ÞACIFIC STANDARD TIME <br /> <br />PREMIUM ADJUSTMENT ENDORSEMENT <br />WC 04 04 07 <br /> <br />ENDORS8M~NT AGREEMENT <br />JUNE 30, 2003 AT 12.01 A.M. <br /> <br />1594455-03 <br />RENEWAL <br />SP <br />2-70-70-02 <br />PAGE lL <br /> <br />CENTENNIAL HERITAGE MUSEUM <br />INC. <br />3101 W HARVARD ST <br />SANTA ANA, CA 92704 <br /> <br />WE HAVE THE RIGHT TO ADJUST THE POLICY PREMIUM AFTER <br />ISSUANCE OF THE POLICY TF THE COST OF PROVIDING nœ <br />BENEFITS REQUIRED UNDER THE WORKERS' COMPENSATION LAWS <br />OF CALIFORNIA IS AFFECTED BY LEGISLATIVE OR REGULATORY <br />CHANGES ADOPTED AFtER ¡ SSUANCE OF THE POLICY. TH~ <br />AMOUNT OF THE ADJUSTMENT WILL NOT EXCEED THE CHANGE TN <br />THE COST OF PROVIDING THE BENEFITS AS REFLECTED IN THE <br />PURE PREMIUM RATES APPROVED BY THE INSURANCE COM!1l~SIONER. <br /> <br />, /~31u¿7 2/q <br /> <br />NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE <br />OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS <br />POLICY OTHER THAN AS STATE!). NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY. ALTER, WAIVE OR LIMIT TIlE TERMS. CONDIfIONS, AGREEMENTS OR <br />LIMITATIONS OF THIS ENDORSEMENT. <br /> <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: <br /> <br />~ <br /> <br />AUTHORIZEO REPRESENTATIVE <br /> <br />JULY 22, 2003 <br /> <br />t1~C. <br /> <br />~ <br /> <br />2023 <br /> <br />PRESIDENT <br /> <br />SCIF FORM "'" IREV.3-0" <br />