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ISO Report 2021
WORKERSCOMPENSATIONEXPERIENCERATING RiskName:BLAIRCITYOFRiskID:260110098 RatingEffectiveDate:11/01/2021ProductionDate:06/23/2021State:NEBRASKA StateWtExpExcessExpectedExpPrimActExcLossesBallastActIncLossesActPrim LossesLossesLossesLosses NE .13138,24446,999154,30637,975234,01679,710 91,245 (A)(B)(C)ExpExcess(D)Expected(E)ExpPrim(F)ActExc(G)Ballast(H)ActInc(I)ActPrim WtLosses(D-E)LossesLossesLosses(H-I)LossesLosses .13 91,245138,24446,999154,30637,975228,62074,314 RatableExcess PrimaryLossesStabilizingValueTotals (I)C*(1-A)+G(A)*(F)(J) Actual 74,314117,35820,060211,732 (E)C*(1-A)+G(A)*(C)(K) 46,999117,35811,862176,219 Expected ARAPFLARAPSARAPMAARAPExpMod (J)/(K) 1.20 Factors REVISEDRATING RATINGREFLECTSADECREASEOF70%MEDICALONLYPRIMARYANDEXCESSLOSS DOLLARSWHEREERAISAPPLIED. REVISEDRATINGTOINCLUDEUPDATEDDATAFOR:NE,POL.#:0H7145618,EFF.:11/01/2017 ©Copyright1993-2021,Allrightsreserved.ThisproductiscomprisedofcompilationsandinformationwhicharetheproprietaryandexclusivepropertyoftheNationalCouncilonCompensationInsurance, Inc.(NCCI).Nofurtheruse,dissemination,sale,transfer,assignmentordispositionofthisproduct,inwholeorinpart,maybemadewithoutthepriorwrittenconsentofNCCI.Thisproductisfurnished“Asis” “Asavailable”“Withalldefects”andincludesinformationavailableatthetimeofpublicationonly.NCCImakesnorepresentationsorwarrantiesofanykindrelatingtotheproductandherebyexpressly disclaimsanyandallexpress,statutory,orimpliedwarranties,includingtheimpliedwarrantyofmerchantability,fitnessforaparticularpurpose,accuracy,completeness,currentness,orcorrectnessofthe productorinformationcontainedtherein.Thisproductandtheinformationcontainedthereinaretobeusedexclusivelyforunderwriting,premiumcalculationandotherInsurancepurposesandmaynotbe usedforanyotherpurposeincludingbutnotlimitedtosafetyscoringforprojectbiddingpurposes.Allresponsibilityfortheuseofandforanyandallresultsderivedorobtainedthroughtheuseoftheproduct andinformationaretheenduser’sandNCCIshallnothaveanyliabilitythereto. Page1of3 WORKERSCOMPENSATIONEXPERIENCERATING RiskName:BLAIRCITYOFRiskID:260110098 RatingEffectiveDate:11/01/2021ProductionDate:06/23/2021State:NEBRASKA 26-NEBRASKAFirmID:FirmName:BLAIRCITYOF Carrier:15539PolicyNo.0H7145618EffDate:11/01/2017ExpDate:11/01/2018 CodeActInc ELRD-PayrollExpectedExpPrimClaimDataIJOFActPrim Losses RatioLossesLossesLosses Z01377076 55062.88.27303,6478,7452,36105F23,18418,000 Z01380116 75202.24.40590,05713,2175,28705F30,10918,000 NO.7 75801.39.32129,3871,79857506*2,1652,165 77052.46.3510,80026693 77113.05.2815,000458128 77201.35.32988,00613,3384,268 8810.08.401,222,049978391 8831.69.4020,38314156 91021.72.40170,0362,9251,170 94022.11.315,36711335 94101.51.4056,856859344 EMPLOYERSLIABILIT 980700 SubjectTotalActInc PolicyTotal:Premium:Losses: 3,511,588138,24655,458 26-NEBRASKAFirmID:FirmName:BLAIRCITYOF Carrier:12211PolicyNo.CIWC929620EffDate:11/01/2018ExpDate:11/01/2019 CodeActInc ELRD-PayrollExpectedExpPrimClaimDataIJOFActPrim Losses RatioLossesLossesLosses 55097896 55062.88.27354,58810,2122,75705O143,29118,000 NO.7 75202.24.40418,6099,3773,75106*4,7334,733 75801.39.32238,5413,3161,061 77113.05.2815,300467131 77201.35.321,088,49914,6954,702 8810.08.40947,792758303 8831.69.4021,72715060 90151.72.40119,8942,062825 92202.07.35211,5264,3791,533 EMPLOYERSLIABILIT 980700 SubjectTotalActInc PolicyTotal:Premium:Losses: 3,416,476106,990148,024 ©Copyright1993-2021,Allrightsreserved.ThisproductiscomprisedofcompilationsandinformationwhicharetheproprietaryandexclusivepropertyoftheNationalCouncilonCompensationInsurance, Inc.(NCCI).Nofurtheruse,dissemination,sale,transfer,assignmentordispositionofthisproduct,inwholeorinpart,maybemadewithoutthepriorwrittenconsentofNCCI.Thisproductisfurnished“Asis” “Asavailable”“Withalldefects”andincludesinformationavailableatthetimeofpublicationonly.NCCImakesnorepresentationsorwarrantiesofanykindrelatingtotheproductandherebyexpressly disclaimsanyandallexpress,statutory,orimpliedwarranties,includingtheimpliedwarrantyofmerchantability,fitnessforaparticularpurpose,accuracy,completeness,currentness,orcorrectnessofthe productorinformationcontainedtherein.Thisproductandtheinformationcontainedthereinaretobeusedexclusivelyforunderwriting,premiumcalculationandotherInsurancepurposesandmaynotbe usedforanyotherpurposeincludingbutnotlimitedtosafetyscoringforprojectbiddingpurposes.Allresponsibilityfortheuseofandforanyandallresultsderivedorobtainedthroughtheuseoftheproduct andinformationaretheenduser’sandNCCIshallnothaveanyliabilitythereto. *TotalbyPolicyYearofallcases$2000orless.DDiseaseLoss XEx-MedicalCoverageUUSL&HW Page2of3 CCatastrophicLossEEmployersLiabilityLoss #LimitedLoss WORKERSCOMPENSATIONEXPERIENCERATING RiskName:BLAIRCITYOFRiskID:260110098 RatingEffectiveDate:11/01/2021ProductionDate:06/23/2021State:NEBRASKA 26-NEBRASKAFirmID:FirmName:BLAIRCITYOF Carrier:12211PolicyNo.CIWC036256EffDate:11/01/2019ExpDate:11/01/2020 CodeActInc ELRD-PayrollExpectedExpPrimClaimDataIJOFActPrim Losses RatioLossesLossesLosses 55110895 55062.88.27339,8129,7872,64205F29,72218,000 NO.3 75202.24.40646,88414,4905,79606*812812 75801.39.32245,1453,4081,091 77052.46.353,3008128 77113.05.2811,700357100 77201.35.321,144,15015,4464,943 8810.08.40958,696767307 8831.69.4023,36216164 91021.72.40197,6943,4001,360 94101.51.40138,6112,093837 EMPLOYERSLIABILIT 980700 SubjectTotalActInc PolicyTotal:Premium:Losses: 3,709,354112,40830,534 ©Copyright1993-2021,Allrightsreserved.ThisproductiscomprisedofcompilationsandinformationwhicharetheproprietaryandexclusivepropertyoftheNationalCouncilonCompensationInsurance, Inc.(NCCI).Nofurtheruse,dissemination,sale,transfer,assignmentordispositionofthisproduct,inwholeorinpart,maybemadewithoutthepriorwrittenconsentofNCCI.Thisproductisfurnished“Asis” “Asavailable”“Withalldefects”andincludesinformationavailableatthetimeofpublicationonly.NCCImakesnorepresentationsorwarrantiesofanykindrelatingtotheproductandherebyexpressly disclaimsanyandallexpress,statutory,orimpliedwarranties,includingtheimpliedwarrantyofmerchantability,fitnessforaparticularpurpose,accuracy,completeness,currentness,orcorrectnessofthe productorinformationcontainedtherein.Thisproductandtheinformationcontainedthereinaretobeusedexclusivelyforunderwriting,premiumcalculationandotherInsurancepurposesandmaynotbe usedforanyotherpurposeincludingbutnotlimitedtosafetyscoringforprojectbiddingpurposes.Allresponsibilityfortheuseofandforanyandallresultsderivedorobtainedthroughtheuseoftheproduct andinformationaretheenduser’sandNCCIshallnothaveanyliabilitythereto. *TotalbyPolicyYearofallcases$2000orless.DDiseaseLoss XEx-MedicalCoverageUUSL&HW Page3of3 CCatastrophicLossEEmployersLiabilityLoss #LimitedLoss