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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 07 E <br /> (Ed. 01-22) <br /> Short Rate Table <br /> Extended Percent of Extended Percent of Extended Percent of <br /> Number of Full Policy Number of Full Policy Number of Full Policy <br /> Days Premium Days Premium Days Premium <br /> 1 . ..... 5% 95-98 37% 219-223 69% <br /> 2 6% 99-102 38% 224-228 ...... 70% <br /> 3-4 ...... 7% 103-105 39% 229-232 ...... 71%0 <br /> 5-6 ...... 8% 106-109 40% 233-237 ...... 72% <br /> 7-8 ..... . 9% I10-113 41% 238-241 73%© <br /> 9-10 ..... . 10% 114-116 42% 242-246 (8 mos.) 74% <br /> 11-12 11% 117-120 ..... . 43%© 247-250 75% <br /> 13-14 .... 12% 121-124 (4 mos.) 44% 251-255 76% <br /> 15-16 ...... 13% 125-127 45% 256-260 77% <br /> 17-18 14% 128-131 46% 261-264 ..... . 78% <br /> 19-20 15% 132-135 ...... 47% 265-269 79% <br /> 21-22 ..... . 16% 136-138 ...... 48% 270-273 (9 mos.) 80% <br /> 23-25 ... 17% 139-142 ...... 49% 274-278 ..... . 81% <br /> 26-29 ... 18% 143-146 50% 279-282 ..... . 82% <br /> 30-32 (1 mo.) 19% 147-149 51% 283-287 ...... 83% <br /> 33-36 . ..... 20% 150-153 (5 mos.) 52% 288-291 ...... 84% <br /> 37-40 . ..... 21% 154-I56 ..... 53% 292-296 ...... 85%n <br /> 41-43 . ..... 22% 157-160 54% 297-301 ...... 86% <br /> 44-47 ..... . 23% 161-164 ...... 55% 302-305 (10 mos.) 87% <br /> 48-51 ...... 24%n 165-167 56% 306-310 ....,, 88% <br /> 52-54 ...... 25% 168-171 ...... 57% 311-314 89% <br /> 55-58 ...... 26% 172-175 58% 315-319 90% <br /> 59-62 (2 mos.) 27% 176-178 59% 321-323 91% <br /> 63-65 . ..... 28% 179-182 (6 mos.) 60% 324-328 ..... 92% <br /> 66-69 ...... 29% 183-187 ..... . 61% 329-332 93%u <br /> 70-73 30%© 188-191 ...... 62% 333-337 (11 mos.) 94% <br /> 74-76 31% 192-196 ...... 63% 338-342 95% <br /> 77-80 ... ... 32% 197-200 ...... 64% 343-346 96% <br /> 81-83 ...... 33% 201-205 ..... . 65% 347-351 .... 97% <br /> 84-97 34% 206-209 ..... . 66% 352-355 ...... 98%b <br /> 88-91 (3 mos.) 35% 210-214 (7 mos.) 67% 356-360 99% <br /> 92-94 36% 215-218 68% 1 361-365 [2 mos. 100% <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective: 04/01/2026 Policy No.: FOWC726350 Endorsement No.: <br /> Insured: Premium$ <br /> Insurance Company: Berkshire Hathaway Homestate Ins Co <br /> Countersigned by <br /> WC 99 06 07 E Page 2 of 2 <br /> (Ed. 01-22) <br />