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WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NO. SATI S 0 3 2 4 6 0 5 <br /> EXTENSION OF INFORMATION PAGE PAGE NO. 2 <br /> ITEM 4.CONTINUED ---- <br /> Rates Per Estimated Annual Premiums <br /> Estimated`total $100 of <br /> CODE Annual Remun- Subject to <br /> CLASSIFICATION OF OPERATIONS NO. Remuneration oration 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, 160 <br /> Expense Constant 0900 200 <br /> Terrorism 974C 0 . 0100 77 <br /> Catastrophe (other than Certified 9741 0 . 010 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 /> SISA Premium Surcharge 0 . 0301480 452 . 00 <br /> DEBT 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 />