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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 06 A <br /> ( Ed . 7-95 ) <br /> PREMIUM DISCOUNT ENDORSEMENT <br /> The premium for this policy and the policies , if any , listed in Item 3 of the Schedule may be eligible for a discount. This <br /> endorsement shows your estimated discount in Items 1 or 2 of the Schedule . The final calculation of premium <br /> discount will be determined by our manuals and your premium basis as determined by audit . Premium subject to <br /> retrospective rating is not subject to premium discount . <br /> Schedule <br /> 1 . State Estimated Eligible Premium <br /> First Next Next <br /> $ 5 , 000 $ 95 , 000 $4003000 Balance <br /> California 0% 3 . 5% 5 % 7 % <br /> 2 . Average percentage discount : 1 . 8 % <br /> 3 . Other policies : <br /> 4 . If there are no entries in Items 1 , 2 and 3 of the Schedule , seethe Premium Discount Endorsement attached to <br /> your policy number: <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 12/11 /2021 Policy No , WWC3560056 Endorsement No . 0 <br /> Insured Tank-Tight Systems Inc Premium $ 10 , 588 <br /> Insurance Company Wesco Insurance Company <br /> Countersigned by <br /> WC000406A <br /> ( Ed . 7-95) <br /> i <br />