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HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT <br />IT 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 BELOW. <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 9226837-19 <br />SEND NO MONEY UNLESS STATEMENT IS ENCLOSED <br />THE RATING PERIOD BEGINS AND ENDS AT 12:01AM <br />PACIFIC STANDARD TIME RATING PERIOD 3-01-19 TO 3-01-20 <br />* INTERIM BILLING RATES WILL BE USED ON PAYROLL REPORTS. THEY TAKE INTO ACCOUNT <br />RATING 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 03-01-19 TO 03-01-20 <br />RATING PLAN MODIFIER 1.10000 <br />ESTIMATED PREMIUM DISCOUNT MODIFIER 1.00000 <br />COMPOSITE FACTOR APPLIED TO BASE RATES TO DERIVE <br />INTERIM BILLING RATES 1.10000 <br />* * <br />* PREMIUM DISCOUNT SCHEDULE EFFECTIVE FROM 03-01-19 TO 03-01-20 <br />* ESTIMATED MODIFIED PREMIUM IS DISCOUNTED ACCORDING TO THE FOLLOWING SCHEDULE: <br />* FIRST ABOVE <br />* $5,000 $5,000 <br />* 0.0% 11.3% <br />* * <br />THE ESTIMATED PREMIUM DISCOUNT IS BASED ON AN ESTIMATE OF YOUR PAYROLL. ACTUAL <br />PREMIUM DISCOUNT APPLIED AT FINAL BILLING WILL BE BASED ON THE ACTUAL PAYROLL <br />REPORTED ON YOUR POLICY AND SUBJECT TO AUDIT. <br />COUNToEF�SIG3NED ANDQIISSUED AT SAN FRANC,O ERDPLEASEI MARCH 4, 2019 POLICY L <br />SCIF <br />VLO-Of <br />PAGE 2 OF 3 j <br />