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HOME DFFSCE SAN FRANCISCO I ANNUAL RATING ENDORSEMENT <br />11' IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATION APPEARING <br />IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BcLnw <br />HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OR ADDRESS SHOULD <br />BE 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 12t01AM <br />PACIFIC STANDARD TIME RATING PERIOD 10 -01 -14 TO 10_01_15 <br />INTERIM BILLING RACES WILL BE USED ON PAYROLL REPORTS. THEY TAKE INTO ACCOUNT <br />RAPING PLAN CREDITS (OR DEBITS) WHICH WILL APPLY AT FINAL, BILLING AND AN <br />ESTIMATE OF YOUR PREMIUM DISCOUNT AS DETAILED BELOW, <br />RATING PLAN CREDITS (DEBITS) EFFECTIVE FROM 10- 01 --14 TO 10-01 -15 <br />RATING PLAN MODIFIER <br />0,87173 <br />ESTLMATED PREMIUM DISCOUNT MODIFIER <br />_ 1..p00pD <br />COMPOSITE FACTOR APPLIED TO BASE RATES TO DERIVE <br />INTERIM BILLING RATES <br />0.87173 <br />rtink h it ik {: it Yrink i; �k in'r :4 ?; in4 fr is ink o4 is k 9c tr is in'ok it i oY;n'r:c tk :'nHni i; ;,ro4 trio e4 rt;k it in'nY � ^, it �vr k irir'nk in? tk it icinYtk :'r fi 1t it i; iak?n4 <br />PREMIUM DISCOUNT SCHEDULE EFFECTIVE FROM 10 -01 -14 TO 10- 01 --15 {, <br />ESTIMATED MODIFIED PREMIUM IS DISCOUNTED ACCORDING TO THE FOLLOWING SCHEDULE; <br />FIRST ABOVE <br />$5,000 $5,000 <br />0.0% <br />t :Hn'nk'c rt � :: Y; ,k r', it it iok 1r 4nk rt r'r tr dr %k it xic fir o'nkr'nk ,b'n4 rt +k {Cet oH: ink>, icir An ok <br />'tFiak t;;tAi;in4inht�kiHc %$t4>4 tk:'n, t4 eYin4:k>'<in'n'; �': <br />THE ESTIMATED PREMIUM DISCOUNT IS BASED ON AN ESI,LNAT'E OF YOUR PAYROLL. AC "IUAI. <br />PREMIUM DISCOUNT APPLIED AT FINAf, BT1..LING WILL DE BASED ON THE ACTUAL PAYROLL <br />REPORTED ON YOUR POLICY AND SUBJECT TO AUUI1', <br />cJ ' <br />)UNTERSIGNED ARID ISSUED AT SAN FRANC 5 <br />SC* FORM 10991A (REV.), 20141 ;,','&4q&f'pKDER 12, 2014 POi.TCv r. nArtr � rvc <br />