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HOME OFFICE SAN FRANCISCO I 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 />CONTINUOUS POLICY 9048876-18 <br />IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT YOUR LOCAL STATE FUND OFFICE BELOW: <br />SANTA ANA <br />1750 EAST FOURTH STREET <br />SANTA ANA , CA 92705 <br />(714) 565-5995 <br />Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions <br />agreements or limitations of the Policy other than as herein stated. <br />When countersigned by a duly authorized officer or representative of the State Compensation Insurance <br />Fund, these declarations shall be valid and form part of the Policy. <br />C\vAa C7 <br />AUTHORIZED REPRESENTATIVES PRESIDENT AND CEO <br />° 2 <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO JULY 3, 2018 <br />SCIF FORM 10963A (REV.7�2014) <br />POLICY L PAGE 3 OF <br />