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Sent By:-Te�n Challenge; 951882357; May-24-05 4:16AM; Paq_e 3 <br />15 2..' -005 1 ; ,7 STaTF Cu,,,' PIS FI.Jh4D 91'=51nR.-3754 11 . -' „_..,.r., <br />STATE - <br />HOME OFFICE SAN FRANCI]GU i ANNUAL RATING ENOORSEMENI <br />I N S U N$ATION <br />I N $ U R A N CG IT IS AGREED THAT T'NF. CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING <br />FUND IN THL CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARF AMENDED AS SHOWN BELOW <br />4CRC ARE YOUR NEW RATES FOR THE. PERIOD INDICATFD IF YOUR NAME OR ADDRESS SHOUIn <br />BE CORRECTED OR IF INSURANCE IS NOT NEEDLE) FOR NEXT YEAR, PI CASE TELL LS, <br />IMPQRTANT THIS IS NOT A BILL CONTINUOUS POLICY 488-04 <br />SEND ND MONEY URLIiSS STATEMENT i$ ENCLOSED CALIFORNIA COUNCIL OF COMMUNITY MENIAL <br />tiEALTa AGENCIES <br />THE RATIM6 PEPICD 4EGINS ANC PROS AT 12:07AM <br />PACIFIC STAMCARD TIME <br />TEEN CHALLENGE OF SO CA , INC RATING PERIOD 2-01-05 TO 2-01-06 <br />PO BOX 5039 UNIT 62b <br />RIVF,RSIDE, CALTP 92517 DEPOSIT PREMIUM $17,301.00 <br />MINIMUM PREMIUM $160.00 <br />PREMIUM ADJUSTMENT PERIOD MONTHLY <br />REP 02 R SP <br />NAME OF EMPLOYFR- TEEN CHALLENGE OF SO CA INC <br />(A NON-PROFIT CORP.) <br />CODE N0. PRINCIPAL WORK AND RATES EFFECTIVE FROM 02-DL-US TO 02-07 06 <br />INTERIM <br />PREMIUM aASE 3I1"1,1NG <br />BASIS RATE RATE* <br />DDU4 ALCOHOLIC AND DRUG RECOVERY HOMES --ALL 1186nnU 1U.53 S.4U <br />EMYLUYIE6. <br />8017 STORES--RETAIL--N.O_C_ 96400 10.70 11.36 <br />8742 SALESPERSONS --OUTSIDE. 35940U 2.11 1.66 <br />8804 SOCIAL REHABILITATION FACILITIES FOR 10,83 8.4E <br />ADUT-TS--ALL EMPLOYEES. <br />8810 CLERTCAL OFFICE EMPLOYEES--N.Q.C. 736000 1.94 1.52 <br />EXPERIENCE MODIFICATION <br />2 D1 35 TO 2-01-06 <br />7% x <br />--------BUREAU NOTE INFORMATION.*.x•... <br />FEIN 952683852 APPROVED <br />A5 7"O <br />Laura Stitt Shccd, —� <br />Assis(aut City 11I,,, Irt, <br />TO-1"AL ESTIMATED ANNUAL PREMIUM $90,400 <br />COUNTERSIGNED AND ISSUED AT SAL`7 FRANCISCO FEBRIJARY 11, 2005 YUI,IC.Y L PACY1: Y OF <br />SCR CORM 10563(REY.5�051 IOVFR PIFASFI <br />