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FW A FLORIDA WORKERS' COMPENSATION WORKERS COMPENSATION <br /> JOINT UNDERWRITING ASSOCIATION$ INC. <br /> AND <br /> EMPLOYERS LIABILITY POLICY <br /> EXTENSION OF INFO PAGE - SCHEDULE WC 00 00 01 ( A ) <br /> POLICY NUMBER : ( GFR1 3UB - 7988B04 - 4 - 05 ) <br /> PREMIUM BASIS <br /> ESTIMATED RATES ESTIMATED <br /> TOTAL ANNUAL PER $ 100 OF ANNUAL <br /> CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM <br /> LOCATION 002 01 ( CONT ' D ) <br /> CHARITABLE OR WELFARE <br /> ORGANIZATION - PROFESSIONAL <br /> EMPLOYEES & CLERICAL 8861 IF ANY 1 . 68 <br /> WELFARE OR CHARITABLE <br /> ORGANIZATION : ALL OTHER <br /> EMPLOYEES & DRIVERS 9110 7435 9 . 38 697 <br /> r <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> TOTAL PREMIUM SUBJECT TO EXPERIENCE MODIFICATION $ 8470 <br /> TENTATIVE EXP MOD : 95 MODIFIED PREMIUM 8046 <br /> TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 8046 <br /> TIER 1 SURCHARGE 2090 <br /> EXPENSE CONSTANT ( 0900 ) 200 <br /> 0 . 0000 TERRORISM RISK INS ACT 2002 ( 9740 ) 110 <br /> ASSIGNED RISK FLAT SURCHARGE ( 9601 ) 475 <br /> TOTAL ESTIMATED PREMIUM 10921 <br /> DEPOSIT AMOUNT DUE 10921 <br /> DATE OF ISSUE : 08 - 01 - 05 SR ST ASSIGN : FL SCHEDULE NO : 2 OF LAST <br />