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Attached to and forming part of Policy No.

issued by the Atlantic Casualty Insurance Company, of New York City, to.

New York, N. Y.,

19

dated.

JOHN DOE Secretary

APPENDIX XVII

MANUAL PAGES

EXPLANATORY

Exhibit A.-Typical manual page taken from the rules section of the workmen's compensation insurance manual.

The exhibit shows the rule covering minimum premiums as it appears in the manual.

Exhibit B.-Typical manual page taken from the classification section of the workmen's compensation insurance manual.

The exhibit shows classifications listed alphabetically, and code numbers for these classifications.

In order to obtain the rate and minimum premium to be applied on any risk, the pages of the type shown in the exhibit are first referred to. When the proper classification is found, the code number which follows the classification is noted.

Exhibit C.-Typical manual page taken from the rate section of the workmen's compensation insurance manual.

The exhibit shows rates and minimum premiums applicable in Massachusetts for a number of classifications.

Similar rate sheets for all classifications and most states which have workmen's compensation laws are inserted in the manual.

Assume that a risk manufactures plate glass. By referring to the pages as shown in Exhibit B, the classification "plate glass manufacturing— polished plate glass-excluding quarrying and excavating" is found. The code number, 4101, is noted. By then referring to the rate sheets, it is found that a rate and a minimum premium for classification No. 4101 are listed. In Massachusetts, as shown in this exhibit, the rate and minimum premium for No. 4101 are $1.45 and $22.00, respectively.

Exhibit D. Typical exception page from the rule section of the workmen's compensation insurance manual.

The exhibit shows the special rules in Massachusetts applying to "coverage" and "contractors."

A number of such pages covering special rules applicable in specific states are inserted in the manual.

Exhibit E.-Typical exception page from the rate section of the workmen's compensation insurance manual.

Similar exception pages for a number of states appear in the manual.

EXHIBIT A

MINIMUM PREMIUMS

A minimum premium is the lowest premium for which a single policy can be written or issued for any period not exceeding one year. When the actual premium computed at the rates specified in the policy is less than the minimum premium specified in the policy, the minimum premium shall be charged, but when the actual premium so computed is greater than the minimum premium specified in the policy, the actual premium shall be charged. If the policy is canceled by the insuring company, the actual premium computed for the time the policy was in force shall be charged unless this amount is less than the pro rata amount of the minimum premium specified in the policy for the time the policy was in force, in which event that pro rata amount of the minimum premium shall be charged. If the policy is canceled by the assured, the minimum premium specified in the policy shall be charged unless the actual premium is greater than the minimum premium, in which event the actual premium shall be charged.

The minimum premium for each classification appearing in the Manual unless otherwise provided will be found opposite the code number of each classification in the column headed "Min. Prem." on the State rate sheet.

If a risk embraces several classifications, one or more of which carries an estimated payroll of $1,000 or more, the minimum premium to be charged shall be that which applies to the highest rated classification which carries an estimated payroll of $1,000 or more. If no classification carries an estimated payroll of $1,000, the minimum premium to be charged shall be that which applies to the highest rated classification named in the policy which carries an estimated payroll or the words "if any." This shall not apply to the "standard exceptions" noted in paragraphs 4 to 8 inclusive which appear in the Manual under “PAYROLL RULES.”

If a policy covers two or more States, the minimum premium to be charged shall be that which applies to the State for which the highest minimum premium is provided.

For minimum premiums for residence and farm policies, see "RESIDENCE AND FARM RULES," pages 18 to 24.

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Plate Glass Mfg.-polished plate glass-excluding quarrying or excavating.

CODE No.

4101

Sheet Glass Mfg.-rolled glass, not polished-including ribbed, colored, figured and wire glassexcluding quarrying or excavating.. Sheet Window Glass Mfg.-blown by mouth or machine-excluding quarrying or excavating.... 4102

4103

Glass Merchants-including operations of bending, grinding, beveling and silvering plate glass.. Glassware Mfg.-no plate or sheet glass manufacturing-no automatic blowing machines..

4130

4111

Glassware Mfg.—no plate or sheet glass manufacturing (N. O. Č.).

4114

Glaziers (away from shop)-including Drivers, Chauf

feurs and their Helpers..

5462

Glove Mfg.-leather.

2670

Glove and Mitten Mfg.-knit (excluding yarn manu

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Grading Land-excluding canal or cellar excavation, quarrying, railroad and street or road construction -including Drivers, Chauffeurs and their Helpers 6041 Grain Elevators-not floating or terminal elevators— operation..

4653

3386

8304

Grain Elevators-terminal-(not floating elevators)operation

8305

Graphite Mfg.—not artificial graphite..

1750

Grease or Oil Mixing or Blending-no rendering (N. P. D. with No. 8350 "Oil Distributing")...... 4712 Gun, Rifle or Pistol Mfg.—excluding shell loading..

3200

EXHIBIT C

COMPENSATION MANUAL.

RATE SHEET-(Continued.)

MASSACHUSETTS. Effective 12.01 A. M., July 7, 1924.

The COMPENSATION RATES and MINIMUM PREMIUMS for this State are shown below opposite the CODE NUMBERS of the various classifications. NOTE: Symbol (a) means "refer to Home Office."

The letter S following any Code Number indicates that the classification is subject to Schedule Rating.

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3681s. .56.. 13. 4101s. 1.45.. 22. 4400s. 1.96.. 27.4596s. 1.02.. 18.

3683s. .62.. 14. 4102s. 1.29.. 21. 4410s.

3685s. .62.. 14. 4103s. 3686s. .64.. 14. 4111s.

3724.. 2.27.. 30. 4112s. 3726.. 3.31.. 40. 4113s. 3801s. (a)

4114s.

1.45.. 22. 4417s.
.84.. 16. 4418s.

.49.. 13. 4420s. .40.. 12. 4431s. 1.14.. 19. 4432s.

1.96.. 27. 4597s. 1.34.. 21. .67.. 15. 4610s. .96.. 17. .57.. 14. 4627s. 1.71.. 25.

1.09.. 19. 4628s. .96.. 17. .48.. 13. 4633s. 2.69.. 34. .48.. 13.4634s. 2.69.. 34.

3803s. 1.24.. 20.4130.. 1.50.. 23. 4440s. 2.38.. 31. 4635s. 2.27.. 30. 3804s. .75.. 15. 4131s. .97.. 17. 4452s. .74.. 15. 4636.. 4.65.. 53.

3805s.

.94.. 17. 4133.. .97.. 17. 4456s. 2.38.. 31. 4653s. 1.29.. 21. 3807s. 1.65.. 24.4150s. .64.. 14.4470s. 1.19.. 20.4665s. 2.02.. 28. 3808s. 1.24.. 20. 4151s. .64.. 14. 4480s. .56.. 13. 4670s. 5.69.. 63. 3811s. 1.65.. 24. 4206s. 2.69.. 34. 4482s. 1.55.. 23. 4671s. 1.91.. 27. 3819s. 1.96.. 27. 4207s. 1.81.. 26. 4484s. .74.. 15. 4683s. 1.91.. 27.

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