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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 Ol B <br />TOWER SELECT INSURANCE COMPANY <br />EXTENSION OF INFORMATION PAGE <br />SCHEDULE OF A-2008-072 <br />CLASSIFICATIONS <br />POLICY NO . <br />FEIN # : 20-1279851 <br />TSIWD7 0813776 00 <br /> Premium Basis Rate Per Estimated <br />Code No. Classification Total Estimated $100 of Annual <br /> Annual Remuneration Remuneration Premium <br />State : California <br />Premium Period : 06/01/2008 to 06/01/2009 <br />8810 CLERICAL OFFICE EMPLOYEES -N.O.C. S 1,999 0.63 328 <br /> Total Manual Premium 32g <br /> Total Standard Premium 32g <br />0900 Expense Constant l60 <br />9740 Foreign Terrorism Premium 0.03 16 <br />9695 California Guarantee Fund Assessment 0.02 ] 0 <br />9681 Califomia Fraud Surcharge Assessment 0.002394 I <br />9682 Califomia Workers' Compensation Admin Fund Assessment 0.0 ] 0703 5 <br />9700 California Uninsured Employer's Benefits Fund Assessment 0.00173 1 <br /> Estimated Annual Premium : 504 <br /> Total Amount Due : 521 <br /> Total Assessments : 17 <br />Page 2 of 5 <br />