Laserfiche WebLink
CHANGE IN INFORMATION PAGE (Continued) <br />Policy Number: 57 WEC AU9LTU <br />SCHEDULE <br />IT IS AGREED THAT THE POLICY IS AMENDED AS FOLLOWS <br />CLASS CODE NUMBER AND DESCRIPTION ESTIMATED <br />TOTALANNUAL <br />REMUNERATION <br />CA - Location 1 <br />Rating Period: 11/08/2024-11/08/2025 <br />8810 <br />CLERICAL OFFICE EMPLOYEES -N O C <br />Rating Period: 11/08/2024-08/19/2025 <br />8810 <br />CLERICAL OFFICE EMPLOYEES -N O C <br />9083 <br />RESTAURANTS - FAST FOOD OR FAST CASUAL <br />Rating Period: 11/08/2024-11/08/2025 <br />9083 <br />RESTAURANTS - FAST FOOD OR FAST CASUAL <br />Rating Period: 08/19/2025-11/08/2025 <br />8810 <br />CLERICAL OFFICE EMPLOYEES -N O C <br />9083 <br />RESTAURANTS - FAST FOOD OR FAST CASUAL <br />Total State Summary <br />Total Class Premium <br />CA Territorial Differential <br />Waiver charge <br />Small Policy Credit <br />Expense constant <br />Terrorism Risk Insurance Program Reau <br />CA User Fund <br />CA Fraud <br />CA Uninsured Employers Benefit Trust <br />CA Subsequent Injuries Benefit Trust <br />CA Occupational Safety & Health Fund <br />CA Labor Enforcement & Compliance Fun <br />California Total Cast <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />27,400.00 <br />21,319.00 <br />21,319.00 <br />27,400.00 <br />RATES PER 100 ESTIMATED <br />OF ANNUAL <br />REMUNERATION PREMIUMS <br />0.769000 <br />0.00 <br />25 <br />0.00 <br />0.020000 <br />2.460400 <br />0.412200 <br />0.150500 <br />1.589100 <br />0.726600 <br />0.710900 <br />0.380000 -104 <br />0.380000 81 <br />5.370000 1.145 <br />5.370000 -1,471 <br />0.380000 23 <br />5.370000 327 <br />I <br />0 <br />56 <br />-14 <br />0 <br />0 <br />0 <br />0 <br />-1 <br />1 <br />0 <br />0 <br />43 <br />Form WC 99 00 06 B (1) Printed in U.S.A. Page 2 <br />Process Date: 08/19/25 Policy Expiration Date: 11/08/25 <br />