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<br />STATE HOME OFFICE SAN FRANCISCO I ANNUAL RATING ENDORSEMENT <br />COMPENSATION IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING <br />INSURANCE <br />FUND IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. <br /> <br />IMPORTANT <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, PLEASE TELL US. <br /> <br />CONTINUOUS POLICY 1801464-07 <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 PERIOD 10-01-07 TO 10-01-08 <br /> <br />* INTERIM BILLING RATES WILL BE USED ON PAYROLL REPORTS. THEY TAKE INTO ACCOUNT <br />RATING PLAN CREDITS (OR DEBITS) WHICH WILL APPLY AT FINAL BILLING AND AN <br />ESTIMATE OF YOUR PREMIUM DISCOUNT AS DETAILED BELOW. <br /> <br />RATING PLAN CREDITS (DEBITS) EFFECTIVE FROM 10-01-07 TO 10-01-08 <br /> <br />RATING PLAN MODIFIER <br /> <br />1.00000 <br /> <br />ESTIMATED PREMIUM DISCOUNT MODIFIER <br /> <br />1.00000 <br /> <br />COMPOSITE FACTOR APPLIED TO BASE RATES TO DERIVE <br />INTERIM BILLING RATES <br /> <br />1 . 00000 <br /> <br />********************************************************************************* <br /> <br />* * <br /> <br />* PREMIUM DISCOUNT SCHEDULE EFFECTIVE FROM 10-01-07 TO 10-01-08 * <br />* ESTIMATED MODIFIED PREMIUM IS DISCOUNTED ACCORDING TO THE FOLLOWING SCHEDULE: * <br />* FIRST ABOVE * <br />* $5,000 $5.000 * <br />* 0.0% 14.7% * <br />* * <br />********************************************************************************* <br /> <br />THE ESTIMATED PREMIUM DISCOUNT IS BASED ON AN ESTIMATE OF YOUR PAYROLL. ACTUAL <br />PREMIUM DISCOUNT APPLIED AT FINAL BILLING WILL BE BASED ON THE ACTUAL PAYROLL <br />REPORTED ON YOUR POLICY AND SUBJECT TO AUDIT. <br /> <br />OUNTERSIGNED AND ISSUED AT SAN FRANCISCO SEPTEMBER 14, 2007 POLICY L PAGE 2 OF 3 <br />selF FOAM 10963A (REV. 03-07) (OVER PLEASEf <br />