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DocuSign Envelope ID: 313DA256-1 EDE-4396-A716-4C53B809027E <br />NORTH CAROLINA <br />WORKERS COMPENSATION INSURANCE <br />EXPERIENCE RATING <br />-1/1M <br />('ROOD' <br />1 . 1 ) : 0 3 1 3'1 D KERN CORPORATTCNI <br />I <br />t_APR I F"k <br />1111M.11 MAI <br />ID, CASUALTY <br />CORPOIU'Ticl; <br />floli.cv <br />0'1/01/13 rn 07/fl1/14 <br />Cartz <br />10.1 <br />Wr: i �' 8 1j 9V 5 <br />A t: un 1 <br />P r I ma " ,, <br />Hxp. <br />1, 111 I <br />cla-Ell Hiki"heL <br />C I 711 j G111--ii 0 <br />T nc)IL L..d <br />Actl.lrll <br />f.' a <br />1")-"s <br />" "x l�6 <br />a <br />pt 2 c ill d <br />("Ock' Typ <br />s <br />1,y; s r; <br />(:')��Io <br />Rely 'D I <br />R'l to <br />Los., <br />il <br />3 4 <br />2 <br />12 G <br />6 0 <br />6 <br />34 65 <br />1), 0 1 <br />J'il06 <br />3 1 '6[) <br />d <br />I <br />i. 1 491 <br />Q;- <br />30? <br />.1014 <br />9 <br />1. 3 i.. <br />J; <br />P0 L 1 7 PL)TA I,S <br />9e' irid <br />/0' 1 / 14 0 07/01/1 <br />Policy <br />"Alc b(}'7(300 <br />Clrlilq '111ml)er <br />4 <br />, 's J ll Opoil <br />C E, s <br />nc., I r r (-,I <br />Ac 7 1,; 1�t 1 <br />-: Ll <br />T p <br />E; c, <br />',"de <br />P'i a:oll <br />R a <br />L F, c, <br />io <br />"11""Ou e-'nlJT Over <br />0042 <br />')Jhi <br />2 <br />2 <br />2") 2 89.1 0 1 <br />A 3 5 J <br />7, <br />16, 0 <br />14' 158 <br />.3 <br />1 L <br />5-)8 <br />:?31,32 <br />i;4 <br />21$,93:? <br />1 L <br />'I 10 <br />01j <br />DI i <br />1'01,V:Y <br />_S00 <br />1 il�- J. <br />07/41/i.5 i:o 07 0 T 1l? <br />I iry <br />OC: 3 6 2 <br />A C t 1'� 1 <br />111iiiiq] V <br />Exp <br />C I ;i i. m 0; 1 laid ,4 3: <br />1 wi r 7 1,,j ♦)pjj U <br />lo 1 <br />'i!T. 1 <br />3 o y y <br />rla I I i mr; <br />Code 'j'yp r,' J,j; c�, I I <br />'on <br />Lo :3 C,1, <br />C"),zn <br />1"i 2; <br />Hate <br />Loy !, (1,; <br />R" I.. I c> <br />04.2 <br />32, 3i <br />_._24 <br />5,0.3 0!5 <br />5 <br />10 396 <br />4 <br />2,1i &1;9 <br />!sZ 0 3 <br />:;97,1(,7 <br />c" 6 <br />