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Wesco Insurance Company WC 99 00 01 C <br /> 4of5 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE <br /> Insured : Tank-Tight Systems Inc Policy Number : WWC3560056 <br /> EXTENSION OF INFORMATION PAGE FOR ITEM #4 <br /> ITEM 4 : SCHEDULE OF PREMIUMS <br /> Premium Basis <br /> Total Estimated Rate Per Estimated <br /> # of Code Annual $ 100 of Annual <br /> Classifications Emps No . Remuneration Remun . Premium <br /> California <br /> Electrical Machinery or Auxiliary Apparatus 3 3724 1801000 7 . 94 14 . 292 <br /> Manual Premium 141292 <br /> Total Manual Premium 141292 <br /> Total Premium Subject To Experience Modification 141292 <br /> Experience Modification N/A 141292 <br /> Schedule Modifier -25 % 9887 -31573 <br /> Renewal Credit : 2 % -214 <br /> Premium Discount 1 . 8 % 0063 - 189 <br /> Terrorism 3 % 9740 54 <br /> Catastrophe (other than Terrorism) 1 % 9741 18 <br /> Expense Constant 0900 200 <br /> Total CA Premium 10 , 588 <br /> WCARF 2 . 2646 % 9999 240 <br /> UEBTF 0 . 0775 % 9999 8 <br /> SIBTF 0 . 6579% 9999 70 <br /> OSHAF 0 . 2584 % 9999 27 <br /> LECF 0 . 2272 % 9999 24 <br /> FRAUD 0 . 4734 % 9999 50 <br /> Total CA Cost 11 , 007 <br /> TOTAL ESTIMATED ANNUAL PREMIUM 109588 <br /> STATE ASSESSMENT 419 <br /> TOTAL COST 11 , 007 <br /> i <br /> i <br />