**STATISTICAL PLAN #37**

**NAMED INSURED:** I.B.M.
**UNDERWRITER:** Chuck Goodell
**DATE:** 5/26

**DIVISION 3, DEPARTMENT 2, EXCESS AND UMBRELLA MODIFICATION OF CSP NON-BUREAU**

| STAT. PLAN | M | M | V | V |
|------------|---|---|---|---|
| 33         | 34 | 35 | 36 | 37 |
| 38         | 39 | 40 | 41 | 42 |
| 43         | 44 | 45 | 46 | 47 |
| 48         | 49 | 50 | 51 | 52 |
| 53         | 54 | 55 | 56 | 57 |
| 58         | 59 | 60 | 61 | 62 |
| 63         | 64 | 65 | 66 | 67 |
| 68         | 69 | 70 | 71 | 72 |

**INDIVIDUAL RISK RATE MODIFICATION FACTOR**

| EXPER. | SCHEDULED | PACK | EXPER. | CLAIM | USD. |
|---------|-----------|------|--------|-------|------|
| 73      | 74        | 75   | 76     | 77    | 78   |
| 79      | 80        | 81   | 82     | 83    | 84   |
| 85      | 86        | 87   | 88     | 89    | 90   |
| 91      | 92        | 93   | 94     | 95    | 96   |
| 97      | 98        | 99   | 100    | 101   | 102  |
| 103     | 104       | 105  | 106    | 107   | 108  |
| 109     | 110       | 111  | 112    | 113   | 114  |
| 115     | 116       | 117  | 118    | 119   | 120  |
| 121     | 122       | 123  | 124    | 125   | 126  |
| 127     | 128       | 129  | 130    | 131   | 132  |
| 133     | 134       | 135  | 136    | 137   | 138  |
| 139     | 140       | 141  | 142    | 143   | 144  |
| 145     | 146       | 147  | 148    | 149   | 150  |
| 151     | 152       | 153  | 154    | 155   | 156  |
| 157     | 158       | 159  | 160    | 161   | 162  |
| 163     | 164       | 165  | 166    | 167   | 168  |
| 169     | 170       | 171  | 172    | 173   | 174  |
| 175     | 176       | 177  | 178    | 179   | 180  |
| 181     | 182       | 183  | 184    | 185   | 186  |
| 187     | 188       | 189  | 190    | 191   | 192  |
| 193     | 194       | 195  | 196    | 197   | 198  |
| 199     | 200       | 201  | 202    | 203   | 204  |
| 205     | 206       | 207  | 208    | 209   | 210  |
| 211     | 212       | 213  | 214    | 215   | 216  |
| 217     | 218       | 219  | 220    | 221   | 222  |
| 223     | 224       | 225  | 226    | 227   | 228  |
| 229     | 230       | 231  | 232    | 233   | 234  |
| 235     | 236       | 237  | 238    | 239   | 240  |
| 241     | 242       | 243  | 244    | 245   | 246  |
| 247     | 248       | 249  | 250    | 251   | 252  |
| 253     | 254       | 255  | 256    | 257   | 258  |
| 259     | 260       | 261  | 262    | 263   | 264  |
| 265     | 266       | 267  | 268    | 269   | 270  |
| 271     | 272       | 273  | 274    | 275   | 276  |
| 277     | 278       | 279  | 280    | 281   | 282  |
| 283     | 284       | 285  | 286    | 287   | 288  |
| 289     | 290       | 291  | 292    | 293   | 294  |
| 295     | 296       | 297  | 298    | 299   | 300  |
| 301     | 302       | 303  | 304    | 305   | 306  |
| 307     | 308       | 309  | 3010   | 3011  | 3012 |
| 3013    | 3014      | 3015 | 3016   | 3017   | 3018 |

**TYPE**

- **Major Class**
- **Premium**
- **Type**
- **Major Class**
- **Premium**

**EXCESS LIMITS**

- **1 BI (100% Annual)**: 0012
- **2 PO (100% Annual)**: 0013
- **3 RT (Annual)**: 0014
- **4 PO (Annual)**: 0015
- **5 Professional**: 0016
- **6 Medical Prof.**: 0017
- **7 Products (BPI)**: 0018
- **8 Products (PDI)**: 0019
- **9 WC**: 0020

**TOTAL PREMIUMS**

- **1 BI (100% Annual)**: $5,222
- **2 PO (100% Annual)**: $5,253
- **3 RT (Annual)**: $5,266
- **4 PO (Annual)**: $5,276
- **5 Professional**: $5,292
- **6 Medical Prof.**: $5,322
- **7 Products (BPI)**: $5,322
- **8 Products (PDI)**: $5,322
- **9 WC**: $5,324