Return On Industrial Insurance2021-2022 Plan Year

july 2021Deadline: May 14, 2021

october 2021Deadline: Aug 27, 2021

january 2022Deadline: Nov 19, 2021

more services than you can shake a 2x4 at

Our seasoned claim reps go straight to L&I on your

behalf to get claims closed quicker. Rest assured,

we’ll keep a pulse on your claim every step of the way.

claims assistance:

The best injury claim is the one that never happens.

Because prevention is our top priority, we’re here to help

you develop and implement effective safety strategies.

safety and prevention:

Our job is to identify risk and assist you with implementing

preventative measures to avoid claims from happening.

If a claim does occur, we offer strategies to help control

the severity and cost of the injury.

risk management:

Our goal is to keep an injured worker engaged in the

recovery process and connected with their employer

to help ensure better outcomes. Each claim is unique,

as is our customized return-to-work strategy approach.

return-to-work:

BIAW — ROII300 Deschutes Way SWSuite 300Tumwater, WA 98501 OR enroll@roii.com

Return On Industrial Insurance2021-2022 Plan Year ENROLLMENT INSTRUCTIONS

nApplicationn Underwriting QuestionnairenROII’s Intro to Retro Class Registration nEnrollment Fee $150 (min.) Check payable to: BIAW Member Services

COMPLETE & INCLUDE

The enrollment fee is 1.5% of your L&I premiums owed between Oct. 1, 2019— Sept. 30, 2020 or $150, whichever is greater. Enrollment fees are pro-rated for quarterly enrollment periods (1.125% for October; .75% for January).

PAYMENT

n(360) 352-7800 n enroll@roii.com

QUESTIONS

DEADLINESJULY ENROLLMENT: MAY 14, 2021

OCTOBER ENROLLMENT: AUGUST 27, 2021

JANUARY ENROLLMENT: NOVEMBER 19, 2021SEND

300 Deschutes Way SW | Suite 300 | Tumwater, WA 98501 | (360) 352-7800 | enroll@roii.com | BIAW.com

ROII PARTICIPATION REQUIREMENTSn Have a positive reporting history with L&In Must have a current written safety plann Must complete underwriting questionnaire prior to the start of the plan year and a follow-up questionnaire every three yearsn Must agree to modified duty and kept-on-salary (KOS) requirements (see Form 3b, section 5c and 5d)n Owner must attend the ROII’s Intro to Retro class prior to the final L&I deadline for enrollment n A current membership in BIAW through an affiliated local home builders association is required to enroll and receive refunds in ROII

2021-2022 Enrollment, Adjustment and Refund Timeline

L&I Requirements and accepted risk classifications on reverse side

L&I Adjustments and ROII Refunds

ROII INFORMATIONThe ROII plan year consists of twelve calendar months beginning on July 1 and ending on June 30 of the following year, as well as the three subsequent annual adjustments, the first of which occurs roughly ten months after the plan year has ended. In total, a plan year lasts forty-six (46) months from start to finish. Member participants are required to continue paying their regular quarterly premiums directly to the Washington State Department of Labor & Industries (L&I) during the plan year.

In April 2023, L&I will calculate the first of three retrospective premium adjustments. The 2021-2022 ROII plan year refunds are based on what the group participants (your company and others) pay in Standard Premiums to L&I and Developed Losses that L&I charges the group for claims with a date of injury between July 1, 2021 and June 30, 2022.

If the ROII group’s Standard Premiums paid exceed its Developed Losses, L&I returns the excess money to the group sponsor. If Developed Losses exceed Standard Premiums paid, member participants may be assessed additional premiums.

Companies that meet program requirements will be automatically re-enrolled for each consecutive new plan year unless a written cancellation request is sent to BIAW or L&I prior to the start of the next plan year.

ROII ROII Enrollment Plan Year

ROII 2021-2022 PLAN YEAR

ROII REFUNDS ARE BASED ON A 25% PRO-RATA/75% PERFORMANCE DISTRIBUTION MODEL nFIRST ADJUSTMENT REFUND all of the 25% pro-rata share NO SECOND ADJUSTMENT REFUND FINAL ADJUSTMENT REFUND distributes all of the 75% performance share nCompany must be a member of BIAW through a local home builders association at the time of refund distribution in order to receive a refund nFor questions regarding adjustments or the refund timeline, contact ROII Director Jenn Kavanaugh at jennk@biaw.com or (360) 352-7800, ext. 123

*Positive companies must have a loss ratio (Developed Losses divided by Standard Premium) below .792 for the plan year to qualify for a refund.

July 1, 2021 - June 30, 2022Oct. 1, 2021 - June 30, 2022Jan. 1, 2022 - June 30, 2022

April 2023: 1st L&IAdjustment (1 of 3)

June 2023: Firstrefund distribution for*positive companies

April 2024: 2nd L&IAdjustment (2 of 3)

No refunddistribution

April 2025: 3rd L&IAdjustment (3 of 3)

June 2025: Final distribution

refund distribution for*positive companies

JULY: Jan. - April OCTOBER: May - Aug. JANUARY: Sept. - Nov.

If your company qualifies, all of your industrial insurance premiums during the plan year will be covered under ROII

0101 Excavation & Grading N.O.C.0103 Drilling & Geophysical Exploration N.O.C.0104 Dredging N.O.C.0105 Fence Erection N.O.C.0107 Undergrd.Utility Line Const. & Pipe laying N.O.C.0108 Sewer & Septic System Construction0112 Sand & Gravel Production including Dealers0201 Bridge, Bulkhead & Tunnel Construction0202 Pile Driving with Water Hazard0210 Asphalt Paving — Streets & Roads0212 Asphalt Paving N.O.C.0214 Concrete Work — Streets & Roads0217 Concrete Work — Foundations & Sidewalks0219 Guardrails, Street Signs & Traffic Lights Inst.0301 Landscape Construction & Renovation0302 Masonry Construction0303 Plastering, Stuccoing & Lathing: Buildings0306 Plumbing0307 HVAC Systems — Installation, Svc. & Repair0308 Lawn Care Maintenance0403 Sign Erection0502 Floor Covering Installation0504 Painting: Building & Structures — Ext. Work0506 Building Moving/Wrecking0507 Roof Work — Construction & Repair

Applies to establishments engaged in all aspects of construction-related services and activities as a primary business undertaking. The following risk classifications (and sub classifications) include operations applicable to Construction and Related Services:

0508 Struct. Steel Erec. — Towers, Tanks & Cranes0509 Overhead Power & Transmission Line Const.0510 Wood Frame Building Construction0511 Glass Installation: Buildings0512 Insulation Inst. & Asbestos Abatement Work0513 Interior Finish Carpentry0514 Garage Door Installation0516 Carpentry N.O.C.0517 Factory Built Home Set-up by Cont./Mfg.0518 Non Wood Frame Building Construction0519 Sheet Metal Siding, Gutter & Downspout Inst.0521 Painting: Buildings — Interior Work0524 Drywall Installation (Discounted)0526 Drywall Taping (Discounted)0527 Drywall Prime/Texture (Discounted)0528 Drywall Stocking (Discounted)0529 Drywall Scraping (Discounted)0530 Drywall Installation0531 Drywall Taping0532 Drywall Prime/Texture0533 Drywall Stocking0534 Drywall Scraping0540 Wallboard Installation — Discounted Rate0541 Wallboard Taping — Discounted Rate0550 Wallboard Installation — Undiscounted Rate

0607-16 TV Antenna or Satelite Dish: Inst., Removal, Svc. and/or Repair0607-17A Safe, Vault, Mail Boxes or Safe Deposit Boxes: Inst., Removal, Svc. and/or Repair0607-17B Lock Sets and/or Dead Bolt Locks: New Installation0607-18 Window Door Blinds, Curtains, Shades & Drapes: Installation0607-19 Advertising or Merchandise Display: Set-up or Removal within Buildings by Non-store Employees

CONSTRUCTION AND RELATED SERVICES RISK CLASSIFICATIONS

SUB RISK CLASSIFICATIONS1108-03 Flat Glass Merchants - No Tempering1108-05 Combined Auto & Flat Glass Merchants - No Tempering1501-09 Military Base Maintenance N.O.C.2903-08 Wood Door, Jamb, Window, Sash, Stair, Molding & Misc. Woodwork: Mfg., Prehanging or Assembly2903-21 Wood Truss: Manufacturing2903-28 Wood Boat: Mfg., Repair or Refinish3402-40 Welding or Cutting N.O.C.4903-06 Marine Appraising

0551 Wallboard Taping — Undiscounted Rate0601 Electrical Wiring: Buildings & Structures0602 Elevator Installation, Service & Repair0603 Machinery Installation, Service & Repair0606 Vending Machine Inst., Service & Repair0608 Telephone & Electrical Alarm System Inst.0701 Dam Construction0901 Shipbuilding or Repair N.O.C.1303 Tele. Co. — All Other Employees N.O.C.1305 TV Cable Co. — All Other Employees N.O.C.1507 Waterworks Operations, Repair & Main’t.1702 Underground Mines1703 Surface Mines1704 Quarries2907 Cabinet & Counter top Manufacturing — Wood2908 Factory Built Housing Manufacturing3101 Redi-mix Concrete Dealers3105 Concrete Products Manufacturing3415 Factory Built Housing Dealers3506 Mobile Crane & Hoisting Services4900 Const. Project or Site Superintendent/Mgr.4901 Consulting Engineers & Architectural Svcs.4910 Property & Building Management Services5208 Iron Works — Shop

A company may be eligible to participate in the group by exception if they are engaged in a construction-related activity that is not assigned to a risk classification listed above. For questions about risk classes, contact ROII Underwriter/Field Services Manager Kristeen Johnson atkrisj@biaw.com or (360) 352-7800, ext. 119.

4903-07 Boiler Inspecting N.O.C.4903-08 Elevator Inspecting4903-10 Inspection of Buildings5206-79 Permanent Yard or Shop Operations; Construction or Erection Contractor6601-04 Security Guards at Construction Sites

L&I REQUIREMENTSnHave an open industrial insurance account with L&In Have filed all required reports, paid all industrial insurance premiums, penalties and interest (or be current with a repayment plan), and not owe a debt to any other section of the Department for the applying account (including sub-accounts) at the start of the plan year (July 1, October 1, January 1) n Be a current BIAW member through a local home builders’ associationn Must separately enroll all sub-accounts that are construction-related (L&I requires construction-related subsidiary accounts to enroll)n The primary nature of the business for applying account(s) must be “construction and related services”

For verification of meeting this criteria for the ROII group, please refer to the list of accepted risk classifications below. Your company must report hours under one or more of the accepted risk classifications below to be eligible.

Is previous L&I # 50% common ownership?

ROII Administrative contact at your company Direct line # Email

ROII Claims contact at your company Direct line # Email

Owner* % of Ownership* Direct line # Email

Owner % of Ownership Direct line # Email

*Required information

L&I Account ID#

Previous L&I Account ID#  

Federal ID# UBI#

LOCAL HOME BUILDERS ASSOCIATION INFORMATIONTo be approved for enrollment and receive refunds in ROII, you must be a BIAW member through an affiliated local home builders association.

Please check one:

I am a current member of the

I have applied to be a member of the

Please send me information on how to become a BIAW member through an affiliated local home builders association.

L&I RELEASE INFORMATIONSigning this release gives BIAW permission to contact anyone at the above-listed company via correspondence for any BIAW related matters. To the Department of Labor and Industries: You are hereby authorized to provide our company’s claim history, premium, losses, statistics, experience modification factor and related industrial insurance data, including all sub-accounts tied to the policy, whether inactive or active, to the Building Industry Association of Washington (BIAW) along with access to the Department’s online Claim & Account Center.

ACCOUNT INFORMATION

Name of local home builders association (list only one)

Name of local home builders association (list only one)

Signature (Owner/Partner/Corporate Officer) Title (Must be Owner/Partner/Corporate Officer) Date

X

—,

—,

FORM 1aROII 2021-2022 PLAN YEARCOMPANY INFORMATION

YES NO

MSN number#

Company name

Mailing address Physical address

City, State, Zip City, State, Zip

Phone Fax

Business type: Sole Proprietorship     Partnership Corporation      LLC        LLP   S Corp Other:

YOUR SIGNATURE MUST BE HAND SIGNED

Same as mailing address

1. Do you employ seasonal workers or shut down during the winter months?

2. Does your company currently contract with a TPA (third party administrator) for claims/loss control or safety-related services?

3. Does your company have a return to work policy?

4. Do you withhold the employee portion of your workers’ comp insurance from your employees?

5. Does your company ever hire new employees through a union hall?

If yes, how often: ___________________________________________________________________________

6. Do you enter into union project agreements?

7. Are you familiar with kept-on-salary (KOS)?

8. Have you ever done KOS on a claim?

9. Have you ever offered modified duty on a claim?

10. Do you currently have elective owner coverage with L&I?

11. Do your employees work in states other than WA?

If yes, where: ________________________________________________________________

12. Do you have an active contractor’s license?

13. Do you use sub contractors?

14. Have you ever had an L&I safety inspection or premium audit?

15. Do you provide health insurance for your employees?

16. Do you have a designated Human Resources person that handles your personnel issues?

If yes, who: ________________________________________________________________

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

FORM 1bROII 2021-2022 PLAN YEARPERSONNEL/HIRING QUESTIONNAIRE

YES NO

Title (Must be Owner/Partner/Corporate Officer)

Date

Company Name: UBI#:

L&I Account ID#:

X

—,

Signature (Owner/Partner/Corporate Officer)

Type or print name

If you own more than one business or are the majority owner of more than one business, L&I will assign a main (primary) account number to your principal business and sub-account numbers for your secondary business or businesses. If L&I does this and you apply to enroll one of your businesses in a retro group, L&I will analyze all of your commonly-owned businesses to determine which will be required to enroll in retro. This is referred to as the “all or nothing rule” and means if one company participates, all must participate if they fall within the same business and industry category of the group you have applied to. You have the option to enroll non-construction related sub-accounts. If you have questions about this requirement, please call the business association above or L&I at (360) 902-4851.

As a member of the sponsoring organization listed above, this employer applies for enrollment in the retrospective rating group sponsored by the organization. L&I will notify the sponsoring organization of acceptance or denial of your applica-tion to participate in the group. It is the responsibility of the sponsoring organization to notify you of this acceptance or denial. As a prerequisite of enrollment, each of your industrial insurance accounts must be in good standing at the time of enrollment or you will not be allowed to participate in retrospective rating.

By signing this document, the employer named above agrees with all of the following conditions:

n L&I will automatically re-enroll the employer as a member of the group in future coverage periods provided the employer’s industrial insurance account is in good standing at the time of re-enrollment. If the employer does not want to participate in future coverage periods, the employer or sponsoring organization must notify L&I in writing prior to the beginning of the respective coverage period.n The employer authorizes L&I to furnish the sponsoring organization or their designee with data and information obtained from the employer’s industrial insurance account(s).n The sponsoring organization will represent the employer in all matters applicable to retrospective rating participation and the employer’s industrial insurance account(s).n The employer agrees to comply with L&I rules, regulations and laws and is bound by the terms of the agreement between the sponsoring organization and L&I.n The employer will cooperate with L&I claims management activities and will participate in the sponsoring organization’s claims management and workplace safety initiatives.n All retrospective rating adjustments that may be earned by the employer will be given to the sponsoring organization. L&I is not involved in the distribution of a group refund to the individual group members except in the case of defunct group.These conditions are in effect immediately and will remain in effect through the term of any agreement between the sponsoring organization and L&I.

NOTE:L&I disclaims any interest in any other contract you may enter into with the sponsoring organization as their prerequisite of your participation in the retrospective rating group that they sponsor and L&I neither approves or disapproves of any language or provision contained in these other contracts. Return this application directly to the above organization. DO NOT SEND THIS APPLICATION DIRECTLY TO L&I.

FORM 2ROII 2021-2022 PLAN YEAR

APPLICATION FOR GROUP MEMBERSHIP Retro ID#: 025

Mail to: Building Industry Association of Washington 300 Deschutes Way SW | Suite 300 | Tumwater, WA 98501

YOUR SIGNATURE MUST BE HAND SIGNED

THIS CONTRACT is made and entered into on the date below (page 3c) between the Building Industry Association of Washington, a Washington State based nonprofit corporation (hereinafter “BIAW”), and the company named within (hereinafter “Participating Member”), including their affiliated subsidiary accounts who are required by the State of Washington Department of Labor & Industries’ (hereinafter “L&I”) regulations to be included in the group as a condition of enrollment as defined by WAC 296-17B-770 who is a Member in good standing with BIAW and a local Washington State building association affiliated with BIAW. RECITALS: A. BIAW has entered into a “Group Retrospective Rating Agreement” (hereinafter “the Agreement”) with L&I pursuant to Chapter 51.18 RCW. Under this Agreement, the Industrial Insurance Premiums of Participating Members for a given Plan Year are combined together to form an insurance pool. L&I then uses this premium to pay workers’ compensation benefits to employees of the Participating Members with injury dates that fall within the given Plan Year. Any excess premiums computed by L&I for each separate Plan Year are returned to BIAW annually and under L&I rules become the exclusive property of BIAW. Excess premiums may be distributed to Participating Members as outlined in the “Distribution of Premium Return” part of this contract.

AND B. The Member company wishes to be a Participating Member of BIAW’s Return on Industrial Insurance (hereinafter “ROII”) retrospective rating group for the July 1, 2021 through June 30, 2022 Plan Year.THEREFORE, in consideration of the mutual promises and covenants contained in this contract, BIAW and the Participating Member agree as follows: 1. Meaning of Terms and Words (a) “Plan Year” – consists of twelve calendar months beginning on July 1, of a given year and ending on June 30th of the following year (Example: July 1, 2021 through June 30, 2022) and the three subsequent annual adjustments the first of which occurs roughly ten months after the Plan Year has ended (April 2023). In total a Plan Year lasts forty-six (46) months from start to finish. (b) “Staggered Enrollment” – L&I allows BIAW to enroll new Participating Members each calendar quarter during a Plan Year. If a Member applies to participate in a Plan Year after the July 1st start date and they are accepted as a Participating Member their participation for the initial Plan Year would start on the first day of the first calendar quarter beginning after the date this contract is executed by BIAW or its designee. This shortened participation period still has the same end date of June 30th of the Plan Year in which they participate.(Example: a Member company submits a contract for consideration on September 1st. If the Member is accepted their first enrollment would start on October 1st and end on June 30th the following year and cover nine calendar months.) The three annual adjustments described in Plan Year above apply exactly in the same way. (c) “Industrial Insurance Premium(s)” – this is the amount of money that a Participating Member pays to L&I quarterly for their industrial insurance coverage. Industrial Insurance Premiums do not include penalties, interest or security deposits that a Participating Member may be required to pay L&I for late payments or other infractions. Industrial Insurance Premiums include the employer paid accident fund and the medical aid fund, stay at work fund and supplemental pension assessment that the employer and worker pay to L&I. (d) “Standard Premium(s)” – this is the accident fund and medical aid fund portion of the Industrial Insurance Premium. (e) “Premium Return(s)” – this is the amount of Industrial Insurance Premiums in the ROII insurance pool that L&I returns to BIAW that is in excess of what L&I needs to pay benefits to employees of Participating Members injured in work place incidents. (f) “Penalties” – this is the amount of additional premium that Participating Members owe if the Plan Year is assessed a penalty by L&I. The limit of a Participating Member’s obligation for Penalties is described in the “Penalties and Liability Limits” part of this Agreement. (g) “Participating Member(s)” – a Member that is part of the ROII retrospective rating group in a given Plan Year. (h) “Member” – any business that pays dues to one of BIAW’s local building association affiliates and dues to BIAW. (i) “Applicant Member” – any Member that is applying to participate in the ROII program. (j) “Good Standing” – a Member of one or more local building associations affiliated with BIAW who is compliant with the local affiliated association by-laws and membership requirements and who is also compliant with BIAW by-laws and membership requirements. (k) “Represent” – refers to BIAW or its designee representing the Participating Member in all claim-related matters before L&I (see Form 2). “Represent” does not include matters that proceed to the Board of Industrial Insurance Appeals (BIIA) or higher courts. The Retro Group and Participating Member are separate entities for legal standing purposes. If a Participating Member wishes to appeal an L&I decision independent of BIAW or its designee, the Participating Member must retain and pay for their own legal counsel. Nothing in this section shall be read as relieving the Participating Member of its obligation to cooperate with BIAW and/or its designee at all levels of claim management and adjudication/appeal. See also sections 5 (k) and 7 (e). (l) “Subsidiary Account” – a term used by L&I to denote that the business is owned entirely by an owner or group of owners who also owns another business or is the majority owner (51%) in two or more businesses (WAC 296-17B-770). 2. Plan SelectionBIAW or its designee makes this selection for the group. Participating Member obligations for any additional premium/penalties is described in the “Penalties and Liability Limits” part of this Agreement. 3. ROII AdministrationBIAW may as permitted by L&I regulation and this Agreement delegate the administrative duties described in the “Administrative Responsibilities” part of this Agreement to a third party administrator or other designee, including Member Services Corporation (MSC). 4. Administrative ResponsibilitiesBIAW or its designee will provide association Members with enrollment procedures for the ROII retrospective rating group program. BIAW or its designee is responsible for the administration of the ROII group including establishing underwriting criteria and participation requirements. BIAW or its designee will determine if claims assistance to Participating Members and safety and loss control services will be performed by Member Services Corporation (MSC) staff or contracted out to an independent third party administrator. All actions and decisions of BIAW or its designee regarding the disposition of the Premium Return, including but not limited to establishing reserves; investment of funds; timing and amount of any distribution of the Premium Return or payments to Participating Members; and expenditures for administrative costs and expenses of the ROII retro group shall be within the sole discretion of BIAW or its designee. BIAW or its designee may at its discretion hire staff or consultants necessary to carry out its obligations and may pay from the Premium Return such compensation for such services as it deems reasonable and proper. Decisions of BIAW or its designee are not subject to challenge and shall be absolute and binding on all Participating Members. 5. Participating Member ObligationsBy completing and submitting this contract to BIAW or its designee, the Applicant Member agrees to all of the following additional conditions and requirements:

Your signature is required at bottom of Form 3c

FORM 3aROII 2021-2022 PLAN YEARBIAW GROUP RETROSPECTIVE RATING PROGRAM AGREEMENT

*PLEASE HAND INITIAL HIGHLIGHTED SECTIONS*

Your signature is required at bottom of Form 3c

INIT

(a) The owner of the Participating Member must attend the ROII’s Intro to Retro class prior to the start of the plan year. (b) The owner (or person authorized to make financial decisions) of the Participating Member must (i) complete the underwriting questionaire prior to the start of the plan year (ii) complete a follow-up questionnaire every three years. (c) The Participating Member will provide modified duty work, to their own injured employee when the worker is unable to return to their regular job when they sustain a workplace injury or illness covered by Washington’s workers’ compensation laws and continue to pay them at their regular pre-injury wage. (d) The Participating Member agrees to provide thirty (30) working days of regular wages (Kept On Salary) for any of their injured employees who are unable to return to any work because of a work related injury or illness and have been restricted from all such work by their attending physician. (e) Each Participating Member agrees to pay BIAW or its designee an annual enrollment/re-enrollment fee. The annual enrollment/ re-enrollment fee is the equivalent of one and one-half percent (1.5%) of the Participating Member’s L&I Industrial Insurance Premium (four most recent calendar quarters). If the Participating Member is part of a Staggered Enrollment, the enrollment/re-enrollment fee will be pro-rated based on the percentage of the Participating Member’s coverage period bears to the Plan Year. In no case shall this fee be less than one hundred and fifty dollars ($150.00).The enrollment fee must be included with this Agreement when it is submitted to BIAW or its designee as a condition of enrollment. As part of the automatic re-enrollment procedure outlined in the “Participating Member Obligations” section of this Agreement, BIAW or its designee may deduct annual re-enrollment fees directly from the Participating Member’s ROII Premium Return. (f) The Participating Member acknowledges and agrees that all Premium Returns from L&I are to be paid to BIAW or its designee. (g) The Participating Member acknowledges and agrees BIAW or its designee may use the Premium Return to pay for all costs and expenses for the operation and administration of the ROII retrospective rating group as directed by BIAW or its designee. (h) The Participating Member authorizes L&I to release all present, future and past workers’ compensation insurance data relative to their industrial insurance account to BIAW or its designee. Workers’ compensation insurance data for the purpose of this Agreement includes but is not limited to claim history, premium payment history, experience factor calculations and injured worker claim files. This authorization remains in effect throughout the entire period of the Participating Member’s obligation for the Plan Year (forty-six months) they are enrolled in and may not be withdrawn. (i) The Participating Member is bound by and shall comply with all laws, rules and regulations of L&I. (j) The Participating Member is bound and shall comply with all rules and regulations as issued by BIAW and/or its designee. (k) The Participating Member is bound by and shall comply with any and all decisions of BIAW or its designee concerning administration of the ROII retrospective rating group. (l) The Participating Member shall participate in loss control and injury prevention efforts recommended and/or required by BIAW or its designee and take other efforts to reduce workplace injuries and their severity. (m) The Participating Member will (i) keep their membership in good standing with BIAW and an affiliated local association for the plan year as defined by 1(a) of this contract and (ii) will keep their industrial insurance account with L&I open and in compliance with Washington Administrative Code (WAC) 296-17B. 6. Distribution of Premium ReturnThe Premium Return to BIAW or its designee is determined by L&I and is based upon: (a) The Plan and participation level (Risk) selected by BIAW or its designee; (b) The aggregate premium, claim costs of the Participating Members; and, (c) Actuarially determined factors developed and applied by L&I. Therefore, a Premium Return for any Plan Year is not guaranteed. L&I regulations provide that any and all Premium Returns payable to BIAW by L&I that are generated by the ROII retrospective rating group and Participating Members is the sole property of the sponsoring organization and not the individual Participating Members. All monies received from L&I held by BIAW or its designee shall be subject to the exclusive management and control of BIAW or its designee. Participating Members shall have no legal right or entitlement to any of the Premium Return or any interest income or other benefit accruing from the investment of the Premium Return until BIAW or its designee distributes amounts to Participating Members. BIAW or its designee, in its sole discretion, determines and authorizes any and all distributions of the Premium Return or portion thereof. Participating Members may not assign or pledge any portion of the Premium Return, interest, income or other benefit that may accrue as a result of investments of the Premium Return to a creditor of a Participating Member nor can any creditor of a Participating Member attach either voluntarily or by operation of law any portion of the Premium Return. The timing and amount of any distribution of the Premium Return and any income produced from the investment of the Premium Return shall be determined by BIAW or its designee in its sole and absolute discretion. The actual distribution of the Premium Return and/or income produced from investment of the Premium Return or portion thereof to Participating Members is based upon a distribution system adopted by BIAW or its designee. Any and all decisions of BIAW or its designee concerning distribution of the Premium Return and/or income derived from investments of the Premium Return are not subject to challenge or modification by any party (i.e. Member of BIAW or affiliated local building association, ROII Participating Member, creditor of a Member or Participating Member, state, federal or local taxing agency). The Participating Member acknowledges and agrees BIAW or its designee may pay ten percent (10%) of the Premium Return applicable to this Plan Year to local affiliated building associations who do not sponsor, market or promote a plan that competes in whole or in part with the ROII plan and ten percent (10%) to BIAW. The allocation of any such fees among and between local associations will be in the sole and absolute discretion of BIAW or its designee. These fees are in consideration for BIAW’s sponsorship of the ROII program and may be used by BIAW or its designee for any purpose. The Participating Member acknowledges that BIAW and/or its designee is/are entitled to any additional compensation (float) which accrues on funds held by BIAW or its designee. This includes, but is not limited to, interest or earnings on Premium Returns received from L&I before the funds are invested as directed by BIAW or its designee and interest earned on funds distributed to Participating Members prior to the Participating Member cashing or depositing the said distribution. 7. Default by Participating MemberAny failure by the Participating Member to comply with the terms herein shall be considered a default, including but not limited to: (a) Failing to pay kept on salary and offer modified light duty work to injured employees as outlined in the “Participating Member Obligations,” sections 5c and 5d, of this Agreement;

FORM 3bROII 2021-2022 PLAN YEARBIAW GROUP RETROSPECTIVE RATING PROGRAM AGREEMENT

*PLEASE HAND INITIAL HIGHLIGHTED SECTIONS*

Signature (Owner/Partner/Corporate Officer) Print or Type Name

Company Name

INIT

(b) Failing to remain a Member in good standing in BIAW or the Participating Member’s affiliated local building association; (c) Engaging in claim suppression or direct pay of medical bills to suppress claims as defined in L&I laws and rules; (d) Under reporting employee work hours or misclassifying employee work hours so as to underpay their L&I premiums; or (e) Designating any other person or entity, other than BIAW or its designee, to represent the Participating Member before L&I in all matters pertaining to a claim.The Defaulting Member shall be deemed to have forfeited any and all rights to any Premium Return and any income produced from investment of the Premium Return for all Plan Years in which they participated, irrespective of the Plan Year in which the default occurred. BIAW or its designee shall not be subject to any claim by the Defaulting Member or any creditor or assignee of the Defaulting Member. Any forfeited Premium Return and/or any income produced from investment of the Premium Return or portion thereof shall be held and distributed to Participating Members in good standing as authorized by BIAW or its designee. 8. Penalties and Liability Limits of Participating MembersThe Applicant Member understands and agrees to all of the following conditions: (a) If the Plan Year is assessed an additional penalty by L&I, the Participating Member will be subject to a penalty not to exceed their pro-rata share of their Standard Premiums that may become payable to L&I for the Plan Year in which they participate. (b) The Participating Member will pay this additional premium as billed by BIAW or its designee to BIAW or its designee immediately upon request of BIAW or its designee. (c) That if the Participating Member fails to pay the additional premium when requested or demanded by BIAW or its designee, the Participating Member will pay an additional interest rate of twelve percent (12%) per annum and compounded daily on the unpaid balance until they have satisfied the debt and that they are directly responsible for this debt and any interest and penalties that may accrue as a result of late payments by the Participating Member until the debt has been fully satisfied. (d) Participating Members will remain liable for any additional premium liability until all adjustments to the Plan Year in which they participated have been completed by L&I and the Plan Year is closed by L&I. (e) That the Participating Member’s liability under this Agreement shall not be extinguished by the Participating Member’s withdrawal, expulsion, membership termination, sale of business or closure. If a corporation or limited liability company, the officers/partners/owners/members agree to be bound by this Agreement and to be personally and jointly liable for this debt. (f) In the event that it is determined that a Participating Member has underpaid their workers’ compensation insurance premiums either by under reporting work hours of employees or misclassifying employee work hours or using a reporting methodology that resulted in an underpayment of Industrial Insurance Premiums, BIAW or its designee at its option may require the Participating Member to pay the difference of their retrospective premium and the premium they actually paid to L&I. For purpose of this paragraph “retrospective premium” shall be the same amount as calculated by L&I in the retrospective rating formula found in WAC 296-17B. 9. Future EnrollmentThe Participating Member will automatically be re-enrolled in future Plan Years unless they (i) notify BIAW or its designee in writing that they wish to discontinue participating in the ROII retrospective rating group no later than one month prior to the start of a new Plan Year or (ii) receive notice from BIAW or its designee that the Participating Member will not be re-enrolled. 10. Contract Amendments Should BIAW or its designee find it necessary to amend, change or alter the terms of this contract, the Participating Member shall be deemed to have agreed to the changed terms and/or obligations for the next Plan Year if (i) BIAW or its designee communicates the changes to the Par- ticipating Member in writing at least two months prior to the start of the next Plan Year and (ii) the Participating Member does not notify BIAW or its designee in writing no later than one month prior to the start of the next Plan Year that the Participating Member wishes to discontinue participating in the ROII retrospective rating group for the next Plan Year. 11. Non WaiverThe rights of BIAW or its designee under this agreement shall be cumulative and the failure on the part of BIAW or its designee to exercise properly any rights given hereunder shall not operate to forfeit or waive any of BIAW’s or its designee’s rights under this contract. 12. Attorney FeesIn the event that BIAW or its designee is required to hire legal counsel to enforce any of the obligations, requirements and/or conditions of this contract against a Defaulting/Participating Member or defend against a claim made by a Defaulting/ Participating Member, the Defaulting/Participating Member agrees to pay all legal fees and costs incurred by BIAW or its designee as a result of any legal action or proceeding. The Defaulting/Participating Member also agrees that the Thurston County Superior Court shall be the exclusive venue for any lawsuits arising under this contract. 13. BIAW IndemnificationThe Applicant Member hereby releases and agrees to indemnify and hold BIAW and/or its designee, and all its or their Members, staff and consultants hired by BIAW or its designee harmless from any and all liability for any decision which may or hereafter be made by BIAW and/or its designee including its staff or consultants with regard to the ROII retrospective rating group, plan risk selection, Participating Member enrollments and distribution of Premium Return (including the disposition of or distribution of any interest, principal and profit). 14. Acceptance in ROIIThe Applicant Member understands and acknowledges that L&I will accept BIAW’s sponsorship of the ROII retrospective rating group only if BIAW complies with all statutory and regulatory requirements of L&I. The Applicant Member also understands and acknowledges that approval to participate in the ROII retrospective rating group rests with BIAW or its designee and is contingent upon L&I’s approval of the Applicant Member to participate in BIAW’s ROII program. This Agreement shall be binding upon the Applicant Member, its successors and assignees and is effective upon approval of this Agreement by L&I and BIAW as outlined in this section (14) of this Agreement.

INIT

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Date

Title — Must be Owner/Partner/Corporate Officer

,L & I Account ID #

*PLEASE HAND INITIAL HIGHLIGHTED SECTIONS*FORM 3cROII 2021-2022 PLAN YEARBIAW GROUP RETROSPECTIVE RATING PROGRAM AGREEMENT

I have read and understand the terms and conditions of this three-page contract SIGNATURE must be HAND SIGNED

1. Do you expect to hire new employees within the next year?

If yes, how many: _________________________________________________________________________

2. Do you obtain a complete work history from all new applicants?

3. Are prior employers contacted to verify previous employment?

If yes, what questions do you ask:

4. Do you have a pre-hire drug testing policy?

If yes, what company do you use:________________________________________________________

5. Does your company require post job offer physicals for new hires?

If yes, what company do you use: __________________________________________________________________

6. Do you refer workers to a specific healthcare facility when/if they’re injured on the job?

If yes, what facility do you refer them to: ________________________________________________

7. Is it your policy to accompany an injured employee to their initial post-injury treatment

whenever possible?

8. Do you perform pre-hire background checks?

If yes, what company do you use: ______________________________________________________________________

9. Do you have a written safety program/manual or Accident Prevention Program (APP)?

If yes, please include a copy of your APP’s table of contents and cover page with your application.

WAC 296-800-14005, as well as ROII, requires employers to have a written APP.

10. Do you have regular safety meetings with your employees?

If yes, how often: ____________________________________________________________________________

Name Title

Company Name

Phone Number Email

L&I Account ID# Person to contact for supporting documents, if different than above

The underwriting questionnaire is designed to help us better understand your company’s hiring, loss control and safety practices. Your answers will be kept confidential and will not be shared with anyone outside of BIAW and ROII staff. We will contact you if supporting documents are needed for verification of your answers. If you have any questions regarding the underwriting questionnaire, please contact Jessica Bass at (360) 352-7800, ext. 132.

—,

YES NO

YES NO

YES NO

YES NO

YES NO

Continued on Next Page

FORM 4aROII 2021-2022 PLAN YEARUNDERWRITING QUESTIONNAIRE

YES NO

YES NO

YES NO

YES NO

YES NO

If yes, please include a copy of your APP’s table of contents and cover page with your application. WAC 296-800-14005, as well as ROII, requires employers to have a written APP.

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

11. Do you have a written disciplinary policy?

12. Do you have a new employee orientation covering all your company policies?

If yes, do you request your employees to sign a document confirming they have read and

understand your company policies?

13. Do you require your employees to report all incidents/accidents immediately?

14. Do you investigate and document injuries after they occur?

15. Does your company create modified/light-duty jobs to accommodate your injured workers?

If yes, list some examples of modified/light-duty jobs you have created:

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

FORM 4bROII 2021-2022 PLAN YEARUNDERWRITING QUESTIONNAIRE

___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________

As a condition of enrollment, the owner of the ROII participating company is required to attend this class prior to the final L&I deadline for enrollment.

Please list the owner and any additional attendee who will be participanting in the class. If you have questions or are unable to attend in-person, please contact ROII Administrative Assistant Linzy Hubbard at linzyh@biaw.com or (360) 352-7800, ext. 134.

FORM 5ROII 2021-2022 PLAN YEARROII’S INTRO TO RETRO - Help Improve Your Bottom Line

Owner Title Attendee Title

Email Email

OwnerOther

LAST CLASS FOR JULY

ENROLLMENT

JULY 2021 ENROLLMENT Must attend a class prior to June 15, 2021All July enrollment classes will be held online from 10 a.m. to 1 p.m. Space is limited, you’ll be contacted if the class if full.

NOTE: We ask that all attendees have video and audio capabilities and keep their camera on during the class. It is important that we are able to see our audience. If you do not have video capabilities, please contact us.

May 25, 2021

May 26, 2021 May 27, 2021 June 1, 2021 June 2, 2021

June 3, 2021

June 8, 2021

June 9, 2021

June 10, 2021

June 15, 2021

More Classes on Next Page

FORM 5ROII 2021-2022 PLAN YEARROII’S INTRO TO RETRO - Improve Your Bottom Line

November 4, 2021HBA of Tri-Cities10001 W Clearwater AveKennewick, WA 99336

November 4, 2021 MBA of Pierce County3711 Center StreetTacoma, WA 98409

November 9, 2021 BIAW300 Deschutes Way SW, Suite 300Tumwater, WA 98501

LAST CLASS FOR JANUARY ENROLLMENT

JANUARY 2022 ENROLLMENT Must attend a class prior to December 15, 2021All class times are 10 a.m. - 1 p.m.

November 2, 2021 Central WA HBA 3301 W Nob Hill Blvd Yakima, WA 98902

November 2, 2021 Kitsap Building Association 5251 Auto Center Way Bremerton, WA 98312

November 3, 2021 BIA of Whatcom County 1650 Baker Creek Place Bellingham, WA 98226

November 10, 2021 SICBA15571A Peterson RdBurlington, WA 98233

November 11, 2021BIA of Clark County103 E 29th StreetVancouver, WA 98663

November 11, 2021 Spokane HBA5813 E. 4th Avenue #201Spokane Valley, WA 9921

September 30, 2021Spokane HBA5813 E. 4th Avenue #201Spokane Valley, WA 9921

September 30, 2021SICBA15571A Peterson RdBurlington, WA 98233

OCTOBER 2021 ENROLLMENT Must attend a class prior to September 30, 2021All class times are 10 a.m. - 1 p.m.

September 1, 2021 BIA of Whatcom County 1650 Baker Creek Place Bellingham, WA 98226

September 2, 2021 Kitsap Building Association 5251 Auto Center Way Bremerton, WA 98312

September 2, 2021 Central WA HBA 3301 W Nob Hill Blvd Yakima, WA 98902

September 16, 2021 Capital Benefits Services 15375 SE 30th Pl #380 Bellevue, WA 98007

September 22, 2021MBA of Pierce County3711 Center StreetTacoma, WA 98409

September 23, 2021HBA of Tri-Cities10001 W Clearwater AveKennewick, WA 99336

September 28, 2021 BIAW300 Deschutes Way SW, Suite 300Tumwater, WA 98501

September 29, 2021BIA of Clark County103 E 29th StreetVancouver, WA 98663

LAST CLASS FOR OCTOBERENROLLMENT