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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY NXT-WC-3.1 <br /> Total Manual Premium $611.00 <br /> Waiver of Subrogation Premium $250.00 <br /> Employers Liability Increased Limits Factor 2.8% $150.00 <br /> Employers Liability Increased Limits Charge or Balance to Minimum Premium $133.00 <br /> Total Subject Premium <br /> Experience Modification Factor 1.0 <br /> Experience Modification charge $0.00 <br /> Total Modified Premium <br /> Schedule Rating Factor 12 5% <br /> Schedule Rating Amount $126.38 <br /> Total Standard Premium $1,137.00 <br /> Premium Discount 0.0 ($0) <br /> Expense Constant $200.00 <br /> Terrorism 0 5% <br /> Catastrophe $8.00 <br /> 1% $16.00 <br /> Estimated Annual Premium <br /> Workers Comp Administrative Revolving Fund Assessment 0.01237 $17.00 <br /> Subsequent Injuries Benefits Trust Fund Assessment Surcharge 0.030148 $41.00 <br /> Uninsured Employers Benefits Trust Fund Assessment 8.18E-4 $1.00 <br /> Surcharge OSHA Fund Assessment Surcharge 3.0 $3.00 <br /> Labor Enforcement Compliance Fund Assessment Surcharge 0.001058 $1.00 <br /> Fraud Account Assessment Surcharge <br /> Insurance Guarantee Association Assessment Surcharge 0.004096 $ <br /> 0.0 $0.00 <br /> .00 <br /> Total Amount Due $1,430.00 <br /> Minimum Premium $500.00 <br /> NXT-WC-3.1 <br /> (Ed. 0624) <br />