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<br /> WORKERS COMPENSATION EXPERIENCE RATING <br />CS1 Risk Name: CITY OF SUNNY ISLES BEACH Risk 10: 091103249 <br /> Rilling Effective Date: 10/01/2011 Production Date: 06/15/2011 State: FLORIDA <br />State Wt SRP Exp Excess Expected Exp Prim Act Exc Losses Ballast Act Inc Losses Acl Prim <br /> Losses Losses Losses Losses <br />rl .24 0 222,562 278,284 55,722 353,145 46,800 406,860 53,715 <br />(Alf(S)1 (e) Exp Excess (0) Expected (E) Exp Prim I (F) Act Exc I (G) Ballast I (H) Act Inc I (I) Act Prim <br />Wt Losses (0 - E) Losses losses Losses (H -I' Losses Losses <br />~[~ 222.56. 278,284 55.7221 353.145j 46,8001 406,8601 53.7151 <br /> <br /> Primary Losses Stabilizing Vlllue Ratable Excess Tolals <br /> (I) C . (1 - A) + G (A)' (F) (J) <br />Actual 53,715 215,947 84,755 354.417 <br /> (E) C ' (1 - A) + G (A) '(C) (K) <br />Expected 55.722 215,947 53,415 325,084 <br /> ~...- <br /> ARAP FLARAP SARAP MAARAP Exp Mod <br /> (J) / (1<) <br />Factors 1,11 1.09 <br /> _._'~. <br /> <br />RATING REFLECTS A DECREASE OF 70% MEDICAL ONLY PRIMARY AND EXCESS LOSS <br />DOLLARS WHERE ERA IS APPLIED. <br /> <br />~~ <br />~ <br /> <br />Copyrigh[ 1993-2011, All rights re$erved. Thrs eJ:.f1ct'~nce IT'lOdtr4eation faclor IS comprised of compilat ons and inlorm,tion which are the pforxietcllrY and ex<;lu5IVt' proper1yof lh&NalIONI <br />Council on Compen$Oilion Insurance, Inc. (NCCI) No further u~e, dis$~minatJor'll, !tale, trans'!r, 8sstgnmenl or diiposHion 01 this experi.nce rab~ moditlccation betor Of' any p~ lhereot <br />may be used w;th()(Jt 1he writtenc:onsent of NCe!. Neel ma~es n~ represent4lbon Of wa,,;nry, expresHd Of Implied, as to In)' matteJwh41lsoe..e( includll"lg blA nollimlte-d to tho 3,ccuraCYQr <br />any Intormat,on, prod~t or servjee furntshed hereunder '00, as to NeCl, recipient of thIS e)Cpi'nence rating modiflnhon fackn sum-cribes to and utilizes. tn.lntOlmat,on servICe "a~ i,~. <br /> <br />Page 1 of3 <br /> <br />000145/000J65 CX1435 T <br />