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<br />0g/22/2008 12:54 <br /> <br />9093g30943 <br /> <br />M SANCHEZ <br /> <br />PAGE 12/14 <br /> <br />STATE HOME OFHCt SAN FRANCISCO I ANNUAL RATING ENDORSEM~NT <br />C::OMPENSA...ION IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUN~RATION APPEARING <br />INSURANcr;; <br />FUND IN TilE CONTINUOUS POLICY ISSUED TO THIS ~MPLOYER ARE AMEND~D AS SHOWN BELOW. <br /> <br />~~ ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OR ADDRESS SHOULD <br />BE I CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR, PLEASE TELL Us. <br />IMPORTAN..,! CONTINUOUS POLICY 469-07 <br />II THIS IS NOT A BILL CALIFORNIA PRIVATE SCHOOL SAFETY COURCI <br />SEND NJ MIlNEV UNLESS STATEMENT IS ENCLOSED L <br />THE RATING PERIOD BEQINS AND ENDS AT 1~: 01AM <br />PACIFIC STANDARD TXME <br /> <br />EAST LA bLASSIC THEATRE CORP <br />2168 S ATLANTIC BLVD PHS 378 <br />MONTEREY PARK, CALIF 91754 <br /> <br />I <br />JAME <br /> <br />CODE J1, <br /> <br />RATING PERIOD 2-01-08 TO <br />UNIT <br />DEPOSIT PRElUUH <br />MINIMUM PREMIUM <br />PREMIUM ADJUSTMENT PERIOD <br /> <br />2-01-09 <br />3546 <br />$1,30B.00 <br />$160,00 <br />MONTHLY <br />R se <br /> <br />OF EMPLOYER- <br /> <br />EAST LA CLASSIC THEATRE CORP <br />(A NON-PROFIT CORP.) <br /> <br />PRINCIPAL WORK AND RATES EFFECTIVE FROIl 02-01-08 TO 02-01-09 <br /> <br /> INTERIM <br /> PREMIUM BASE BILLING <br /> BASIS RATE RATE* <br />8868-1 COLLEGES OR SCHOOLS--PRIVATE 534157 1.95 1.51 <br />8810-1 CLERICAL OFFICE EMFLOVEES--N.O.C. 248825 1.01 .78 <br />9154-1 THEATERS--NOT MOTION PICTURE 26247 6.66 5.16 <br />9156-1 THEATERS--DANCE, OPERA AND THEATER 72829 8.80 6.82 <br /> COMPANIES--ALL PERFORMERS AND DIRECTORS <br /> OF PERFORMERS--N.O.C. <br />- <br /> <br />EXPERIENCE MODIFICATION <br />2-01-08 TO 2-01-09 <br /> <br />84 . <br /> <br />********BUREAU NOTE INFORMATION******** <br /> <br />- <br /> <br />FEIN 954532421 <br /> <br />',,0 A.. <br /> <br />A <br /> <br />~ <br /> <br />,."l.-." <br /> <br />T AL ESTIMATED ANNUAL PREMIUM $13,726 <br /> <br />IUKTERSIGNED ANb ISSUED AT SAN FRANCISCO MARCH 4, 2008 POLICY L PAGE <br />!!icn: FORM 109G3A IREV, 1r-071 fOVER PLEASEln- <br /> <br />1 OF 3 <br />