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WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICYNO. SATIS0324605 <br /> EXTENSION OF INFORMATION PAGE <br /> ITEM 4,CONTINUED PAGE NO. 2 <br /> Rates Per Estimated Annual Premiums <br /> Estimated Total $100 of <br /> C CODE Annual Remun- Subject to <br /> CLASSIFICATION OF OPERATIONS <br /> NO. Remuneration eration Modification All Other <br /> CA-4 Intrastate ID:4653388 <br /> LOC. 1 <br /> Employees: 1 <br /> NAICS : 624190 <br /> 1505 East 17th Street, Suite 214 <br /> Santa Ana, (Orange) CA 92705 <br /> Premium Discount 0063 -1, 180 <br /> Expense Constant 0900 200 <br /> Terrorism 9740 0 . 0100 77 <br /> Catastrophe (other than Certified 9741 0. 0100 77 <br /> Acts of Terrorism) <br /> California Assessment 0 . 0123700 186 . 00 <br /> Fraud. Assessment 0 . 0040960 61. 00 <br /> CIGA Premium Surcharge 0 . 00 <br /> SIBA Premium Surcharge 0 . 0301480 452 . 00 <br /> UEBT Fund Surcharge 0 . 0008180 12 . 00 <br /> OSHF Fund Assessment 0 . 0018850 28 . 00 <br /> LECF Assessment 0 . 0010580 16 . 00 <br /> TOTAL ESTIMATED PREMIUM 14 , 999 <br /> TOTAL ASSESSMENTS 755 . 00 <br /> TOTAL CA ESTIMATED PREMIUM 14 , 999 <br /> TOTAL CA ASSESSMENTS 755 . 00 <br /> WC000001A <br />