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08/10/2005 13:55 94977PIF NCADD <br />PAGE 02 <br />STATEHOME OFFICE �; r?UJ FRANCISCO I111ANNU/�ATIN(, ENDORSEMENT <br />1 N S U F1 A CIO IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 ()F REMUNERATION APPEARING <br />--�I F ,KfO IN THE CONTINUOUS POLICY ISSUED TO THIS EMPI DYER ARE AMENDED AS SHOWN BELOW. <br />HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF YOUR NAME OA ADDRFSS 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 400989--05 <br />SEND NO MONEY UNLESS STATEMENT IS ENCLOSED <br />HE RATING PERIOD BEGINS AND PNOS AT 12:01AM <br />ACIFIC STANOAnD TIME RATING PERIOD 6-23--05 TO 6-23-06 <br />NATIONAL COUNCIL ON ALCOHOLISM DEPOSIT PREMIUM $2,75.1.00 <br />22471 ASPAN ST STE 103 MINIMUM PREMIUM $200.00 <br />LARE FOREST, CALIF 92630 PREMIUM ADJUSTMENT pERIOD ISONTHLY <br />REP 03 R SG <br />NAME OF EMPLOYER- NATIONAL COUNCIL ON ALCOM01TSM <br />(A NON-PROFIT CORP.) <br />CODE NO. PRINCIPAL WORK AND RATES EFFECTIVE FROM 116-23-05 TO 06-23-06 <br />INTERIM <br />PREMIUM BASE BILLING <br />BASIS RATE RATE* <br />8810 CLERICAL OFFICE EMPLOYEES--N.O.C. 567399 1.94 1.71 <br />8868 COLLEGES OR SCHOOLS --PRIVATE 405356 4.50 3.96 <br />EXPERIENCE MODIFICATION <br />6-23-05 TO 6-23-06 <br />********BUREAU NOTE INFORMATION'�k***** <br />FEIN 951910946 <br />TOTAL ESTIMATED ANNUAL PREMIUM $22,628 <br />88 X <br />INTERSIGNED.AND ISSUED AT SAN FRANC SCO MAY 13, 2005 POLICY L PAGE I OF <br />SCIr FORM 10963 ;NEW I -I,) OVER PLEASP <br />