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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED <br /> WC 99 06 03 <br /> Worker's Compensation and Employer's Liability Policy Payment Schedule <br /> Policy Number: MWC0106102-01 <br /> Issued to: Senior Care of Orange County Inc <br /> Effective Date:02/08/2017 <br /> Month Payment <br /> 02/08/2017 $270.00 <br /> 03/08/2017 $168.00 <br /> 04/08/2017 $168.00 <br /> 05/08/2017 $168.00 <br /> 06/08/2017 $168.00 <br /> 07/08/2017 $168.00 <br /> 08/08/2017 $168.00 <br /> 09/08/2017 $168.00 <br /> 10/08/2017 $168.00 <br /> 11/08/2017 $168.00 <br /> If you elect a payment plan,then you will be subject to installment fees for each payment ranging from$3-$10 depending on <br /> the state. If you elect electronic funds transfer,these fees will not apply. <br /> ©1991 National Council on Compensation Insurance. 4 of 24 <br />