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DocuSign Envelope ID: B94F2D40-3B3C-47A7-86C2-6F1 B4F92C62C
<br /> WORKERS COMPENSATION EXPERIENCE RATING
<br /> 1VCCI Risk Name: SASSER CO INC Risk ID: 914011531
<br /> Rating Effective Date:02/01/2019 Production Date: 11113>2018 State: INTERSTATE
<br /> M!".
<br /> NINA
<br /> n�x^r�v���'i� < s�a�r i��s r4.. ...,E�cess � FFxpeced Exp �f[n�'� '� ewv� Lo55es,,R
<br /> VL .11 .14 24 10 0 28,800 0 0
<br /> Nc .10 48,036 67,859 19,824 39,582 36,000 65,007 25,425
<br /> sc .10 3,7904;948 1;158 0 34,750 0 0
<br /> � E�flata �M.., ,.a. t �ti Ae6�1At: ri
<br /> osG�e ( E Losses t oss saes{H �L uses L
<br /> �`m:.�.t�:�.x_., .,� a,�,�a::T o_-����.�,..,w;.� _ �. ��w��s, •
<br /> 10 61,839 \ ` 72,8311 20,992{L 39,582 35,913 58760 19178
<br /> -
<br /> (f) C*(1 A)+G (A) (F) (J)
<br /> Actual 19,178 82,568 3,958 105,704
<br /> (E) C*(1 -A)+G (A)*(C) (K)
<br /> Expected 20,992 82,568 5,184 108,744
<br /> a � P�7LARAI ' ,. tZARA� x
<br /> (J) (K)
<br /> Factors 1.00 1.00 .97
<br /> REVISED DATING
<br /> RATING REFLECTS A DECREASE OF 70%MEDICAL ONLY PRIMARY AND EXCESS LOSS
<br /> DOLLARS WHERE ERA IS APPLIED.
<br /> THE ARAP FACTOR SHOWN IS FOR THOSE STATES CONTAINED ON THIS
<br /> RATING THAT HAVE APPROVED THE ARAP PROGRAM AND IS CALCULATED
<br /> BASED ON THE STATE WITH THE HIGHEST APPROVED MAXIMUM ARAP
<br /> SURCHARGE.THE MAXIMUM ARAP SURCHARGE MAY VARY BY STATE.
<br /> PLEASE REFER TO EACH STATE'S APPROVED RULES FOR THE
<br /> APPLICABLE MAXIMUM ARAP SURCHARGE.
<br /> RATING REVISED TO REFLECT APPROVED RATING VALUES
<br /> ®Copyright 1993-2019,All rights reserved.This product Is comprised of compilations and Infonnatlon which are the proprietary and exclusive property of the National Councll on Compensatlor Insurance,
<br /> Inc.(NCCI).No further use,dlssemination,sale,transfer,assignment or disposition of this product.In whole or in part,may be made without the prior written consent of NCCL This product Is fumished'As
<br /> Is-'As available°With all defects"and Includes Information evallallo at the time of publieallon only.NCO]makes no represemathns or wanandes of any kind relating to the product and hereby expressly
<br /> dlscialms any and all express,statutory,or Implied warranfles,Including the Implied warranty of merchantaloNty,fitness for a particular purpose,accuraoy,completeness,currentness,or correctness or the
<br /> product or information contained therein.This product and the Information contained therein are to be used exclusively for underwritng,premium calculation and other Insurance purposes and may not be
<br /> used for any other purpose Including but not Ilmitad to safety soot[ng for project bldding purposes.A[]responslblllty for the use of and for any and all results derived or obtained through the use of the product
<br /> and Infonnadcn are the end user's and NCCI shall not have any liability thereto,
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