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Public oferred Premium Agency plan Memorandum oCollection f Agreement The State Compensation Insurance Fund does hereby South San Joaquin Irrigation District, the undersigned Policyholder agree with , that: In consideration of the receipt of a promissory note, collateralized by a Resolution of the South San Joaquin Irrigation District Governing Board Payment in the amount of Thirtyguaranteeing Hundred Twenty Dollars ($38,520)EathSixhand aThree ve Quarter percent (6-3/48) interest per annum, ion plan for your 1987 to July 1, 1988. we will extend a deferred premium collect workers' compensation insurance, policy period July 1, The plan includes the following elements: A minimum of forty percent (408) of the annual workers' compensation premium and forty percent (408) of the required deposit premium will be paid during the policy period. The paid portion of the deposit premium is due and payable in cash at policy inception. The paid Portion of the premium is divided over the policy period. If a payroll audit reveals that less than forty percent (40%) of the premium was paid, the balance of that amount Will be billed and will be due and payable in cash at that time. In the event that payroll audit reveals that more than Sixty percent (608) of the required premium was deferred, the Policyholder agrees to make up the balance by signing an amendment to the Promissory Note and Memorandum of Agreement and obtaining any necessary amendments to collateral or by paying the balance in cash at the time of payroll audit. At the option of the policyholder, State Fund will accept a replacement Note from the Policyholder for the premium owed if such Note is executed thirty (30) days prior to the maturity date of the Note it replaces. If the Policyholder opts to execute a replacement Note, such Note shall be effective from the maturity date of the Note it replaces, mature no more than fourteen (14) months from that date and be written pursuant to the same terms as the Note it replaces. The interest earned during the policy period is due and payable in cash at the time of the final audit but in no case more than one hundred fifty (150) days after policy expiration. The interest earned after the expiration date of the policy is due and payable in cash twelve (12) months after policy expiration but in no case later than sixty (60) days after the last day of the month in which the promissory note matures. r STATEINSURAN10E • UND 1275 MARKET STREET - SAN FRANCISCO, CALIFORNIA 94103