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HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT <br />IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OE REMUNERATION APPEARING <br />IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. <br />HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED IF YOUR NAME OR ADDRESS SHOULD <br />RE CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR, PLEASE TELL US, <br />IMPORTANT THIS IS NOT A BILL CONTINUOUS POLICY 1375240 -14 <br />SEND NO MONEY UNLESS STATEMENT IS ENCLOSED <br />THE RATING PERIOD BEGINS AND ENDS AT 12;OIA14 <br />PACIFIC STANDARD TIME RATING PERIOD 10-01 -14 TO 10-01-15 <br />ORANGE <br />COUNTY <br />LABOR FEDERATION <br />DEPOSIT PREMIUM <br />$1,271,00 <br />, AFL, <br />- CIO <br />MINIMUM PREMIUM <br />$31.5.00 <br />309 N <br />RAMPART <br />ST STE A <br />PREMIUM <br />ADJUSTMENT PERIOD <br />MONTNLY <br />ORANGE, <br />CALIF <br />92868 <br />R SP <br />NAME OF' <br />EMPLOYER- <br />ORANGE COUNTY LABOR <br />FEDERATION, AFL -CIO <br />(A LABOR UNION) <br />CODE NO. PRINCIPAL <br />WORK <br />AND RATES EFFECTIVE <br />FROM 10 -01 -14 TO 10-01--15 <br />INTERSM <br />PREMIUM BASE <br />BILLING <br />BASIS RATE <br />RATE" <br />8810 -1 CLERICAL OFFICE EMPLOYEES--N,O.C, 488955 1.03 ,90 <br />""""BUREAU NO'T'E INFORMATION***"*** <br />FEIN 950614067 <br />FEIN 330267027 <br />FEIN 330486694 <br />TOTAL ESTIMATED ANNUAL PREMIUM $4,390 <br />COUNTERSIGNED AND ISSUED AT SAN FRANCI"�� AI�TE�'MBER 12, 201 -4 POLICY L PAGE 1 OF 3 <br />SCIF FORM �0963A (Revs -201d) <br />