FRIENDS OF SANTA ANA ZOO (FOSAZ)

Home Browse Search

HOME OFFICE SAN FRANCISCO ANNUAL RATING ENDORSEMENT IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $900 OF REMUNERATION APPEARING IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENDED AS SHOWN BELOW. HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OR ADDRESS SHOULD BE CORRECTED OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR, PLEASE TELL US.. , IMPORTANT THIS IS NOT A BILL CONTINUOUS POLICY 9048876-18 SEND NO MONEY UNLESS STATEMENT IS ENCLOSED THE RATING PERIOD BEGINS AND ENDS AT 12:09AM RATING PERIOD 7-01-18 TO 7-01-19 PACIFIC STANDARD TIME t; INTERIM BILLING RATES WILL BE USED ON PAYROLL REPORTS. THEY TAKE INTO ACCOUNT RATING PLAN CREDITS (OR DEBITS) WHICH WILL APPLY AT FINAL BILLING AND AN ESTIMATE OF YOUR PREMIUM DISCOUNT AS DETAILED BELOW. RATING PLAN CREDITS (DEBITS) EFFECTIVE FROM 07-01-18 TO 07-01-19 RAPING PLAN MODIFIER 1.09154 ESTIMATED PREMIUM DISCOUNT MODIFIER 0.90611 COMPOSITE FACTOR APPLIED TO BASE RATES TO DERIVE INTERIM BILLING RATES 0.98906 iHxk':i::'ri:'ci;i;icicici;ix:::ki; ie ixiric ie ir4a irieicir.'x ic'.c :c:':i:i:xi:>nFi:i: dx irvHnkiririroaeok:`, icic is i; is is is -.k i;:k:c:k dri<irivie kicin4ir;kic ie :k PREMIUM DISCOUNT SCHEDULE EFFECTIVE FROM 07-01-18 TO 07-01-19 is k ESTIMATED MODIFIED PREMIUM IS DISCOUNTED ACCORDING TO THE FOLLOWING SCHEDULE: * FIRST ABOVE $5,000 $5,000 0.0% 11.3% it irinki<iri<:Fe; iriric::okix i:icicirin;tieokskiriok i<ic':icn:ic:ki:i;i::kin: ic:kaP it 9<iri<'riric >'ao; ic'.; i; is is ;4'cici:i:i:ic nieiririr k:t ;e rt ie i; ic'.c': is THE ESTIMATED PREMIUM DISCOUNT IS BASED ON AN ESTIMATE OF YOUR PAYROLL. ACTUAL PREMIUM DISCOUNT APPLIED AT FINAL BILLING WILL BE BASED.ON THE ACTUAL PAYROLL REPORTED ON YOUR POLICY AND SUBJECT TO AUDIT, ® A a A�58,(q. 0 C-1 ;OUNiTEQ$I7GNEDRAND TISSUED AT SAN FRANC I�QVERPLEASEIJULY 3, 2018 POLICY L PAGE 2 OF 3