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.'1$1001\.1' Covncj(lil . CCllf>pCnla))n InS'Jh1nc9.lr,c Important InformatKln MoUl YourWlIkers O:rnpensalion Insurance Dear Policyrolder: The Nalional Council on Compensation Insurance, fnc, (NCCI), headquartered in Boca Ralon, Fbrida, is the nation's largest informal ion rompany selVlng the wOlkers rxmpensalion malkelplace We provide inforrnalion selvices to state funds, seIHnst/reds, indepenclenl bureaus, insurance agents, regulatory aUlhorities, insurance oompanies, and employers like you A copy of }Qur current experience raling worksheet is enclosed NXI calculates your rating annuaUy on behalf of the insurance industry. The experience rating modifIer, detailed on this wOfl<sheel, is one of the factors used to calculate your oorkers compensafion insurance premium. A copy of ~ur oorl~heel will be senl to you each year as part of NeD's conlinuing effo/1s to Increase employer awareness of safely in Ihe workplace and its im- pact not onty on your employees, bul on your bollcm line, Please remember, SAFElY in Ihe workplace is one of the besl wa:p to reduce WJrkers compensation insurance rosts, Your experience raling factor can be found in Ihe botlcm righf corner of the sumnary. A factor higher Ihan 1.00 means }Qur premium will be higher than lhat of the average company in your category For excmple, a facta of 1. 10 means your base premium WIll be surcharged 10 percent A faclor of .90 means you have earned a 10 percent credit on }Qur base premilln Many items ~llpact your final experience factor, including your payroll classification(s), your payroll, the fre- quency of injuries to your employees, and the dollar value of those injuries (Ihe amount of medical and lost wage benefits paid 10 your injured employees as well as lhe amount of money held in reserve to pay oonlinuing benef/ls) This information is reported to NCCI annually by your insurer. If you have any questions regarding your experience rating, YOll should rontact }QUf insurance agent or insur- ance rompany for assistance, II is also reeonmended that you retain this wOI~.sheet for ~ur tiles and for rom- parison to future annual calculations.