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POLICY ADJUSTMENT NOTICE <br />The premium we charged for your enclosed Hartford policy was based, in part, on estimates and assumptions related to <br />items such as payroll, sales revenue, and the nature of business operations for the policy period shown. When your <br />coverage period expires, a premium audit will be conducted to ensure the premium you paid for your insurance was <br />accurate. In order to complete the premium audit, when your policy coverage period expires you may receive, via e-mail <br />or US Postal mail, a request to complete an "Insured's Report of Exposure" Form. Alternatively, you may receive notice <br />that a Premium Audit representative will be contacting you to review your records and discuss your business operations <br />over the phone or in person. The purpose of the statement, phone call or visit is for the Premium Audit Department to <br />collect the information required to ensure that the premium you paid for your coverage was accurate. <br />Once the audit is complete, you will receive a Statement of Premium Adjustment which will reflect the amount of your <br />policy auditable premium, and will indicate whether you are owed a refund or if additional premium is due for the policy <br />period shown. <br />If we owe you a return premium, The Hartford will apply the refund amount to any current account balance. If your <br />account is paid in full, or if your refund amount is greater than the current account balance, we will issue <br />you a refund check. You can expect to receive this check within the next 30 days. <br />If you owe us an additional premium, the entire amount will appear as due and payable on your next bill. This amount <br />will appear as "Premium Audition your bill. <br />If you have any questions regarding the Premium Audit process, please call your insurance agent. <br />Thank you for doing business with The Hartford. <br />Form G-3058-1 Printed in U.S.A. <br />Rime Management DMsian <br />REVIEWED&APPROVED By: <br />'� Risk Management Analyst <br />