FRIENDS OF SANTA ANA ZOO (FOSAZ) 7-2016

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POLICY NO:9048876-15 DATE: June 26, 2015 PAGE 2 OF 4 "Premium" means the sum derived from the application of California workers' compensation rates to the remuneration of employees or other unit of exposure after application of any duly authorized experience modification. Premium was not otherwise modified except as follows: Premium reflected rating -plan modifiers and premium discount. Estimated annual premium (EAP) is that premium, based upon information supplied by the policyholder or its broker at the time of policy inception, which will be earned during the policy period. The EAP used in the dividend calculation may be greater than the initial EAP provided that during the policy term A) the policyholder notifies STATE FUND of an increase in payroll, B) STATE FUND recalculates the EAP, and C) the policyholder pays all bills resulting from the recalculation on a timely basis. No dividend shall be paid on any premium owed or paid as a result of an audit. Surcharges or assessments were not included in the premium for dividend purposes. EAP is sometimes a different amount than "earned premium". Earned premium is not a factor in the calculation of the dividend. "Losses" means only the case incurred losses on all claims reported under the policy including both paid losses and reserves for the unpaid portion of such claims. No IBNR (Incurred But Not Reported), LDF (Loss Development Factor), LCF (Loss Conversion Factor) or any other factors, charges or provisions were utilized in the determination of losses for dividend purposes, except as follows: Losses were not a factor in the calculation of the dividend. RETENTION Retention was not a factor in the calculation of the dividend. DIVIDEND DETERMINATION AND TIMING The number of policy years' experience used in our plan(s) and our practice concerning loss valuation date(s), dividend calculation date(s), payment schedule and, if applicable, recapture provision, recalculation schedule, forfeiture, reduction or deferral was as follows: Dividends were scheduled for calculation at 18 months AJ6 'the_, policy inception date. Only policies whose initial written term of coverage in t ✓ 4 policy year exceeded 335 days were eligible to receiv am, 15302 I04-2015)