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APPENDI A-1 <br /> BIG INDEPENDENT CITIES EXCESS POOL Ex ibit CA-3 <br /> EXPERIENCE RATING <br />2001/02 to 2003104 Claims with Reportetl Incurretl Losses Over a $250 ,000 Threshold as of December 31, 2004 <br />I. Claims Over $250 ,000 Threshold <br /> Claims <br /> Over <br /> Claims Claims Claims $250,000 <br /> Over Over Over Thresholtl <br /> $250,000 $250.000 $250,000 2001 102 to <br /> Threshold Thresholtl Thresholtl 2003/04 <br />City 2001 /02 2002/03 2003/04 (2)+(3)+(4) <br /> (2) (3) (4) (5) <br />(1) <br />Huntington Beach 3 3 0 6 <br />Oxnard 2 1 0 3 <br />Sen Bernardino 2 0 2 4 <br />Sanle Ane 0 1 1 2 <br />West Covina 1 0 0 1 <br />Total 8 5 3 i6 <br />II. Percent Claims Over a $250.000 Thresholtl <br /> Percent <br /> Percent Percent Percent Claims <br /> Claims Claims Claims Over <br /> Over Over Over $250,000 <br /> 8250.OD0 $250,000 $250,000 Thresholtl <br /> Thresholtl Threshold Thresholtl 2001102 to <br /> 2001102 2002103 2003104 2003104 <br />City <br />Huntington Beach 3Z 5% 60 .0% 0. 0°a 3L 5% <br />oxnam 2s. o% zD .D% D. o% 1e. e% <br />San Bernardino 25. 0% D .D% fi6 ]% 25. 0% <br />Santa Ana 0. 0% 20 .0% 33. 3% 12. 5°0 <br />West Covina 12. 5% 0 .0% 0. 0% 6. 3% <br />Total 100. 0% 100. 0°> 100. 0% t00. D% <br />BICEP_LICA_123104_sample_valued (OS-10-O6) xis <br />