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Ted Holcomb <br />443 <br />c. <br />p.~ <br />~~A~~ Httf~ OFFICE SAH FRANICISCU ANNIUAL AATItYG ENOpRSEMEl11T <br />CO MFENSAT'ION <br />>V S V Ft A N C E R IS AGREED TtfAT T!t!: OLASSiFICATIONS AiVD RATES PER 5100 OF REiM1NEFlAT1pN APPEARttrG <br />~~~ ~ iN TH6 Ct?NTINUOUS Pta~tC~l' ISSUED TO THIS EMPLOYER AFIE AlIAENQF~ A,S SHOWN BEltyl/i[. <br />Dec 14 07 10:01a <br />rcnC /MnC IVUn nCw tSA1C3 tVli THt PEHI(7~ INDICATE O_ F YOUR NAME pq 11pp}lEgg Bti{~ULD <br />BE CORRtcCTED tJR lF 1N51JFiANCE IS NOT NtSEt]~ FOA NEXT YEAR, PLEASE TELL USr. <br />~MPORTaNT Tti1S IS NOT A BILL Col+lrln~t,~0us POLICY 1648138-07 <br />SEND !10 YgNEY UNLESS STATEMENT IS ENCLDSEp <br />THE RATING PERIOD BEGINS AND ENDS AT 12:09AN R~IT i?IG PERIOD 4-O 1-D 7 TQ 4-O 1-O S <br />PACIFIC STANDARD TIME <br />NORTH AMERICSN AMETSSMEhTTS, INC DEPOSIT' PRI£MIIJlE $44, 649.00 <br />11101 CALABASH AVS MII~IIMUM PREMIUM $354.00 <br />FONTANA, C14GIF 9233? PRBMIIIM ADi7T1STMENT PERIOD IIpHTALq <br />~I' 31 R SII <br />NAi'LE OF EMPLOYER- lIORTH A>'iF.RICAN AiSUSEtiENTS, INC <br />(A GORPORATZ02~1) <br />CODE [~. PitI1YCIPAL WORE Al~'D RATES EFFECTI{fE FROM 04-O1-Q7 Fp 04-d1-4$ <br /> INTERIM <br /> PRE?SIUH SASE BII.LINC <br /> BASIS RATE RATB~ <br />9026-1 AMUSEN[ENT PARISS 4R E?~IBITIONS 383573 i©. D1 8.55 <br />8810-1 CLERICAL OFFICE EMPLOYEES--N,O.C_ 29287 1.16 .99 <br />9180-1 AMUSENSENT PARtfS OR EX}IIBITIONS ?2?392 7.7T 6.63 <br />EXPERIENCE riODIFICATIaN <br />4-01-07 20 4-01-08 326 x <br />*x*et~:***BUREAEI N03'E INFORMATION*~°~`=~`* <br />FEIN 330708455 <br />FEIN 33Q744a8$ - <br /> <br />TOTAL ESTIMATSD ANNUAL PAE'lRIUl~ $134, 285 <br />-~N ~'SogM I gi~ED ~D ~I 5 SiJSD AT S~iN FA]!NC I~ 3CO ~R I L 12 , 20 0 7 POLICY L FAfiE 1 OF <br />OvEft PLEASE <br />3 <br />25A-19 <br />