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,xa <br />F � <br />WORKERS OWPI #RATK#tANKIPM <br />tR/ a I <br />INMAWCF. POUCY <br />EMPLOYERS Mir Do <br />POR rNumbwwfill;262aaeoeo <br />A M** <br />.�t <br />w4IMUS <br />7110 "1"FRESNE) STRUT, SUITE 260 <br />NwrW_ mad HARRY <br />ACCALA <br />MERIN, CA 63,120,2999 <br />Agast: �NEPNoRKfti iNs CA 4ta.Y <br />I t <br />EXTENSION OF INFORMATION PAGE <br />CI.ASSIFIGATION OF OPERATIONS <br />Code <br />Premium Basis <br />Rate Per <br />Estimated <br />No. GlassifloattDn ORscriptitxs <br />Total Est. Annual <br />$100 of <br />AAnnual <br />Remuncratem <br />m <br />Remuneration <br />Pmrmum <br />Catlftxrea � <br />._.. <br />Rating Period: 0510112018 through 0610112019 <br />Site 00GO1 <br />$968 COLL 39S 6R SCHOOLS-@RTVATE-NU'" AUTOMOBILE <br />2,268 <br />I.540000 <br />35,00 <br />SCN4'+teS-PROFSS5,:R5, TEACHERS OR ACAUaMIC <br />PROFESSIONAL SHPLOYx9S <br />9101 COLLEONS OR SCHOOLS-PRIVA76-NOT AUTOMOa ILE <br />U <br />9.06e000 <br />E LS-ALL EMPLOYERS OTHER THAN PR1?FE§SCRs, <br />TRACHSR3. OR ACADEMIC PROFESSIONAL <br />RVAGOYE2S-IncLUDIM CAFETERIAS, <br />Site 00001 'total <br />5 <br />35.00 <br />Total of Silos for Rating Period <br />$ <br />35.00 <br />Rating Period Total <br />5 <br />35,00 <br />Rating Period: 0610112018 through 06101I2oi9 <br />0900 EXPENSE CONSTANT <br />5.00 <br />t79917 REDUCE Trt'r MINIMUM PREMIUM <br />49495.00 <br />DS3& STATE N,C, FRAUD ASSRSSNENT <br />75 <br />C.Go2SS0 <br />2.00 <br />0535 STATE A.C. AIRIMIMAT'IVE ASSESSNEhr <br />752 <br />0937 ca INSURANCE otiA Tx <br />7>}. <br />0.1000 <br />D.020ecD <br />xs.cD <br />01138 CA UNINSURED RRAL MRS KIND <br />752 <br />0.0005,13 <br />0919 CA SUNSMOINI T INJURY YEN,ti <br />752 <br />0003599 <br />0940 (SHOP ASSESSMENT <br />752 <br />0.002655 <br />2.00 <br />0943 LABOR IMPORCWtMT & C lRL1ANCB <br />752 <br />0.002150 <br />2.00 <br />9741 CATASTROPHE ARBUTUS <br />21288 <br />0. 040000 <br />1100 <br />9740 TERRORISM PREMIUM <br />2.2,48 <br />U.0300Cii <br />1.60 <br />Ratiol; Period Total <br />$ <br />7A7.$0 <br />'... State Total <br />S <br />762«00 <br />Policy Total <br />5 <br />702.00 <br />