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<br />'. <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 />CONTINUOUS POLICY 1801464-07 <br /> <br />IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT YOUR LOCAL STATE FUND OFFICE BELOW: <br /> <br />CSC - POLICY AT FAIRFIELD <br />5251 BUSINESS CENTER DRIVE <br />FAIRFIELD . CA 94585 <br />(877) 405-4545 <br /> <br />Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions <br />agreements or limitations of the Policy other than as herein stated. <br /> <br />When countersigned by a duly authorized officer or representative of the State Compensation Insurance <br />Fund. these declarations shall be valid and form part of the Policy. <br /> <br />r~ <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />~(~~- <br /> <br />PRESIDENT <br /> <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO SEPTEMBER 14, 2007 POLICY L PAGE 3 OF 3 <br /> <br />selF FORM 10963A (REV. 03-07) <br />