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<br />9-04-2002 1, 5l2IPM <br /> <br />FROM <br /> <br />P.2 <br /> <br />STATE _E OFfICE SAN fllANc:lSCD I ANNUA~ RATING ENDORSEMENT <br />COU.....SATION IT IS AGREED THAT TlfE C~SSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING <br />IN$UlAANCE <br />F=UND IN TlfE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. <br /> <br />HERE.ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OR ADDRESS SHOULD <br />BE. CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT .YEAR, P~EASE TELL US. <br /> <br />CONTINUOUSPOLICV 1256726-02 <br /> <br />IMPORT ANT <br /> <br />THIS IS NOT A BILL <br />SEND NO MONEY UNLESS STATEMENT IS ENCLOSED <br />THE RATING PERIOD BEGINS AND ENDS AT 12:01AM <br />PACIFIC STANDARD TIME <br /> <br />RATING P~RIOD <br /> <br />7-01-02 TO <br /> <br />PRECISION POWDER COATING <br />1236 NORMANDY PL <br />SANTA ANA, CALIF 92705 <br /> <br />DEPOSIT PREMIUM <br />MINIMllM PREMItJM <br />PREMIUM ADJUSTMENT PERIOD <br />REp 07 <br /> <br />NAME OF EMPLOYER- DAVID MICHAEL BELLI <br />(AN INDIVIDUAL EMPLOYER AND NOT JOINTLY <br />WITH ANY OTHER EMPLOYER) <br />CODE NO. PRINCIPAL WORK AND L~TES EFFECTIVE FROM 07-01-02 TO 01-01-03 <br /> <br />INTERIM <br />BASE BILLING <br />RATE RATE* <br /> <br />8810 <br /> <br />CLERICAL OFFICE EMPLOYEES~-N.O.C. <br /> <br />1.93 <br /> <br />1.64 <br /> <br />9501 <br /> <br />PAINTING--SHOP ONLY--N.P.D. <br /> <br />13.51 <br /> <br />11.49 <br /> <br />_ ,EXPERIENCE MODIFICATION <br />7~01-02 TO 7-01-03 <br /> <br />123 % <br /> <br />- <br /> <br />APPROVED AS TO FORM <br /> <br />~ (2c?q~, ..513 <br />(.t,r;;:~edY / <br /> <br />D"putv City Attornev <br />. . <br /> <br />7-01-03 <br /> <br />$1,369.00 <br />$650.00 <br />MONTHLY <br />R SP <br /> <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO <br /> <br />JULY 16, 2002 POLICY FORM L <br /> <br />1 <br />