# RETROSPECTIVE PREMIUM ENDORSEMENT - THREE YEAR - PLAN D

**Effective Date:** 5-21-79
**Endorsement Number:** 89-06-923
**Insured:** LBS
**Insurer:** ZURICH INSURANCE CO.

## 1. Endorsement

The premium for the three-year period is subject to the following conditions:

### 1.1 Endorsement of Premium
The premium for the three-year period is subject to the following conditions:
- The premium for the first year is calculated based on the actual experience of the policyholder.
- The premium for the second and third years is calculated based on the average of the actual experience of the policyholder over the first two years.

### 1.2 Maximum Retrospective Premium
The maximum retrospective premium for the three-year period is subject to the following conditions:
- The maximum retrospective premium is the amount obtained by multiplying the sum of the actual premiums paid during the first two years by the applicable factor.
- The applicable factor is determined by the insurer based on the actual experience of the policyholder.

### 1.3 Definition of Losses
The definition of losses under this endorsement is as follows:
- Losses are defined as the difference between the actual premiums paid during the first two years and the maximum retrospective premium.

### 1.4 Calculation of Losses
The calculation of losses under this endorsement is as follows:
- The loss for each year is calculated by subtracting the maximum retrospective premium from the actual premiums paid during that year.
- If the loss for any year is negative, it is set to zero.

### 1.5 Payment of Losses
The payment of losses under this endorsement is as follows:
- The insurer will pay the loss for each year to the policyholder.
- The insurer will also pay the loss for the third year if the policyholder elects to continue the policy beyond the third year.

## 2. Express Loss Premium
The express loss premium is subject to the following conditions:
- The express loss premium is calculated based on the actual experience of the policyholder.
- The express loss premium is subject to the same conditions as the retrospective premium.

## 3. Secured Policy
The secured policy is subject to the following conditions:
- The secured policy is subject to the same conditions as the retrospective premium.
- The secured policy is subject to the same conditions as the express loss premium.

## 4. Interpretation
The interpretation of this endorsement is as follows:
- This endorsement is subject to the same conditions as the retrospective premium.
- This endorsement is subject to the same conditions as the express loss premium.

## 5. Retention for Multiples of Express Loss Premium
The retention for multiples of the express loss premium is subject to the following conditions:
- The retention for multiples of the express loss premium is calculated based on the actual experience of the policyholder.
- The retention for multiples of the express loss premium is subject to the same conditions as the retrospective premium.
- The retention for multiples of the express loss premium is subject to the same conditions as the express loss premium.

## 6. Miscellaneous
The miscellaneous section is subject to the following conditions:
- The miscellaneous section is subject to the same conditions as the retrospective premium.
- The miscellaneous section is subject to the same conditions as the express loss premium.

MM 009618