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<br />_ Risk Name: CITY OF SUNNY ISLES BEACH
<br />
<br />WORKERS COMPENSATION EXPERIENCE RATING
<br />
<br />Rating Effective Date: 10/01/2011
<br />
<br />Productfon Date: 06/1512011
<br />
<br />09-FLORIDA
<br />
<br />Firm ID:
<br />
<br />State: FLORIDA
<br />
<br />Risk ID: 091103249
<br />
<br />Firm Name: CITY OF SUNNY ISLES BEACH
<br />
<br />Carrier: 38849
<br />
<br />Policy No. WCFL 101320280708
<br />
<br />! Code ELR -/ R~tio j----P;yro"l E~::~~~d
<br />
<br />5509 .2,nT .15 01 0
<br />7380 2,201. .21 5,460! 120
<br />7382 2,16~1 214,359. 4,630
<br />~_~~_ ~46,915L 46,533
<br />6810 .10 ,22 2,890.496L 2,890
<br />8820 ,07 .20 364.648l 255 .
<br />9015 1.63 ,22 836,390 13,633
<br />9102 1.36 ,22 795,305 10.8161
<br />194021 2.35 .1B 45,144 1,0611
<br />~~ 12.402
<br />r ~~~
<br />IPollcy Total: 9,802,812 Premium:
<br />
<br />09-FLORIDA
<br />
<br />Ef1' Date: 10/0112007
<br />
<br />Exi> Prim
<br />Losses .
<br />
<br />Claim Dala IJ OF
<br />
<br />Exp Date: 1010112008
<br />
<br />o 0153194
<br />25 0154650
<br />1,019 0147128
<br />8,376 NO, 18
<br />636 0147836
<br />51 0152876
<br />2,999 0152605
<br />2,36Oj 0155084
<br />191
<br />2,728
<br />
<br />441,478
<br />
<br />uJ
<br />
<br />Total Act Ino
<br />Losses:
<br />
<br />5 F
<br />5 F
<br />5 F
<br />6 .
<br />6 F
<br />6 F
<br />6 F
<br />16 F
<br />..I
<br />
<br />Firm 10:
<br />
<br />Firm Name: CITY OF SUNNY ISLES BEACH
<br />
<br />Exp Dale: 10/0112009
<br />
<br />Carrier: 31860
<br />
<br />Polley No. FMIT0820
<br />
<br />Eft Date:
<br />
<br />10/01/2008
<br />
<br />Act Ine
<br />Losses
<br />4,178J
<br />6,207
<br />6,432
<br />
<br />10.233
<br />2,267
<br />
<br />2.930
<br />4.049
<br />6.210
<br />
<br />42,506
<br />
<br />Act Prim '
<br />Losses i
<br />4,1781
<br />5,ooOJ
<br />5,000
<br />10.233
<br />2.267
<br />2,930
<br />4,049
<br />5,0001
<br />
<br />.1
<br />
<br />Code ELR D. Payroll Expected EXpP~ ~m~ IJ OF Act Ine Act Prim ,
<br /> Ratio Losses Losses .....,..... . Losses losses
<br /> -
<br />7382 2.16 .22 226,420 4,891 1,076 WC20D911213 5 F 3,789 3.789
<br />7720 1.35 .18 3,457,800 46,680 8.402 WC200911 rB7 5 F 4,570 4,570
<br /> 2,648,406/ -
<br />8810 .10 .22 2.648 583 WC200911217 5 F 21,862 5,000
<br />8820 .07 .20 353,8161 248 50 WC200811035 5 0 162,281 5,000
<br /> -
<br />9015 1.63 .22 914,0561 14.699 3,278
<br />9102 1.36 .22 1.203,5481 16,368 3,601
<br />9402 2.361 .18 I 50.6991 1.191 214
<br />9410 1.03 .22 1.531,053 15,770 3.469
<br />9765 WORKPLACE SAFETY C -2.164 -436
<br />9841 DRUG FREE CREDIT -5,3021 -1,067 --~-W I ,
<br />-.- 1---.---- -
<br />9944 PREMIUM CREDIT FOR _.~L. 0 1 I I I
<br /> Subject 304,2451 Total Act Inc
<br />Policy Total: 10,385,798 Premium: Losses: 192.502
<br />
<br />Copyright 1993.2011, All rlgNs '.,.N9d. Th" eJlCpenence mOChf,catJo" factor is comprised or COmpilation, and inforrnation which OIIre lhe pfQpfletary and exclysrve propertyot the National
<br />Counctl on CompqnsatfOl1 Insurance,lne {Nea) No rurther use, dissemination. ..r~ .Ira....ster. 35Sign~t or disposilion or this expenence ,,'ing mochhcatlonf.ctct Of any part thereof
<br />may be used WIthout the wr~en conse,,' of Neel Neel make, no repri!senration or w~"an!y. expren.d or impied. ,$ to any m.ah~ whatsoever indudlng but not limited 10 the acwracy 01
<br />an... ",foanat)oll, product or s.er\lll::e ttJtnisl1ed "ereUf1de.r and. as to Neel, lecrpient of Ihis C'llpellence rating fJ'I()diflCahonfaclOf sub~cnbes to and utilizes the- inlcm1ation seJVice ~as lS~_
<br />
<br />, T 0101 by Po~cy Year of all e.... $2000 Of I... 0 Di.ease Loss
<br />C Cata&(rophi~ los.s E Employets liability Loss
<br />
<br />Page 2 of 3
<br />
<br />X Ex~Medical Cov."g.
<br />"limIted los,s
<br />
<br />UUSl&HW
<br />
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