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<br />e WC <br /> <br />, ' ~ , Page 1 of 1 1/ tJ ~s; <br />AJiJDARD WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY EXTENSION FORM "J:J:'eb <br /> <br />775-46-69 FLORIDA 091192950 <br /> <br />Policy Prefix & No. <br /> <br />Schedule <br /> <br />INTRA/Independent State Risk 10 <br /> <br />013-82-0904-00 <br /> <br />SILTEK GROUP INC <br /> <br />Item 4. Classification of Ooerations <br /> <br />Pre;'iu~ B~si~ ::k Rates <br /> <br />Entries in this item. except as specificalJy provided elsewhere in this policy, <br />do not modify any of the other provisions of this policy <br /> <br />Code <br />No <br /> <br />Estimated Total <br />Annual Remuneration <br /> <br />Per $100 of <br />Remuner(ltion <br /> <br />Estimated <br />Annual Premiums <br /> <br />RATING GROUP: 0001-01 <br /> <br />CARPENTRY NOC <br />CONTRACTOR-EXECUTIVE SUPERVISOR OR <br />CONSTRUCTION SUPERINTENDENT <br />CARPENTRY: DWELLINGS-THREE STORIES OR <br />LESS <br />CLERICAL OFFICE EMPLOYEES NOC. <br /> <br />5403 <br />5606 <br />5651 <br />8810 <br /> <br />75, DOC 31. 10 23.325 <br />132.00C 4.57 6.032 <br />175,OOC 30.55 53.463 <br />88, DOC 0.62 546 <br /> 83.366 <br /> 1,167 <br /> 84.533 <br /> -14.371 <br /> 70. 162 <br /> 70.162 <br /> -2,315 <br /> 67.847 <br /> 200 <br /> 2.501 <br /> 70.548 <br /> 70.548 <br /> <br />STATE OF FLORIDA TOTALS <br />TOTAL' CLASS I F I CAT ION PREMI UM <br />I NCRE,AS ELI M I TS <br />TOTA~:UNMODIFrED PREMIUM <br />EXPERiENCE PREMIUM (ACTUAL) <br />MODIFIED STANDARD PREMIUM <br />UNDI$COUNTED PREMIUM <br />PREM~~M DISCOUNT <br />~COUNTED PREMIUM <br />WENSE CONSTANT <br />TERRORISM RISK INS ACT 2002 <br />TOTAL ESTIMATED PREMIUM <br /> <br />1 . 40~ <br /> <br />9812 <br />9898 <br /> <br />0.8300 <br /> <br />-3.30~ <br /> <br />0064 <br /> <br />3 . OO~ <br /> <br />0900 <br />9740 <br /> <br />ANNUALIZED TOTAL <br />EXPERIENCE RATING MODIFICATION 0.83 <br /> <br />-- <br /> <br />WC 7754 (Ed, 4-81) <br /> <br />See Name and Address Schedule - WC990610 <br /> <br />INSURED'S COpy <br />