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DocuSign Envelope ID:418ADAA3-2F7B-4243-AF32-4541C164B6FA <br /> 104 1 INI <br /> 41itil IN <br /> McG° .7, SEIBELS & 1 . S,INC. <br /> December 29, 2015 <br /> To Whom It May Concern: <br /> Effective 12/31/15,the modifier for D.H.Griffin infrastructure will be 1.06. The increase in the modifier <br /> is due to one claim that happened on 01/05/2012, The claim is a back strain/injury. This claim is In <br /> dispute. <br /> Please find attached the NCCI Worksheets that supports the modifier calculation and verification of the <br /> one claim. I have also included the past year's worksheets to verify there are no other historical losses. <br /> In the last five years, D.H.Griffin Infrastructure has only had this one claim. <br /> Should you have any questions, please call me at 205-581-9468. <br /> Sincerely, , <br /> ------:—--,. <br /> A <br /> ,cr--Te—,„At \ ,JV <br /> 71' " CIL <br /> L...—: ) 'N 113 <br /> Shari Hanby <br /> Senior Vice President <br /> 2211 7th Avenue South/Birmingham,Alabama 35233 <br /> RU. Box 10265 / Birmingham, Alabama 35202-0265 <br /> TEL—(205)252-9071 FAX—(205)581-9293 <br /> www.mcgriff.com <br />