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POLICYHOLDER NOTICE <br />YOUR RIGHT TO RATING AND DIVIDEND INFORMATION <br />I.Information Available to You <br />A.Information Available from Us -Hartford Casualty Insurance Company <br />(1)General questions regarding your policy should be directed toyour Hartford Agent or <br />Hartford Casualty Insurance Company <br />3600 Wiseman Blvd <br />San Antonio, TX 78251 <br />Telephone:(877) 287-1312 <br />agency.services@thehartford.com <br />www.thehartford.com <br />(2)DividendCalculation.Ifthisisaparticipatingpolicy(apolicyonwhichadividendmaybepaid),upon <br />paymentornon-paymentofadividend,weshallprovideawrittenexplanationtoyouthatsetsforththe <br />basisofthedividendcalculation.Theexplanationwillbeinclear,understandablelanguageandwill <br />expressthedividendasadollaramountandasapercentageoftheearnedpremiumforthepolicyyear <br />on which the dividend is calculated. <br />(3)ClaimsInformation.PursuanttoSections3761and3762oftheCaliforniaLaborCode,youareentitled <br />toreceiveinformationinourclaimfilesthataffectsyourpremium.Copiesofdocumentswillbesuppliedat <br />your expense during reasonable business hours. <br />Forclaimscoveredunderthispolicy,wewillestimatetheultimatecostofunsettledclaimsforstatistical <br />purposeseighteenmonthsafterthepolicybecomeseffectiveandwillreportthoseestimatestothe <br />Workers'CompensationInsuranceRatingBureauofCalifornia(WCIRB)nolaterthantwentymonthsafter <br />thepolicybecomeseffective.Thecostofanysettledclaimswillalsobereportedatthattime.Attwelve- <br />monthintervalsthereafter,wewillupdateandreporttotheWCIRBtheestimatedcostofanyunsettled <br />claimsandtheactualfinalcostofanyclaimssettledintheinterim.Theamountswereportwillbeusedby <br />the WCIRB to compute your experience modification if you are eligible for experience rating. <br />B.Information Available from the Workers' Compensation Insurance Rating Bureau of California <br />(1)TheWCIRBisalicensedratingorganizationandtheCaliforniaInsuranceCommissioner'sdesignated <br />statisticalagent.Assuch,theWCIRBisresponsibleforadministeringtheCaliforniaWorkers' <br />CompensationUniformStatisticalReportingPlan—1995(USRP)andtheCaliforniaWorkers' <br />CompensationExperienceRatingPlan—1995(ERP).WCIRBcontactinformationis:WCIRB,1901 <br />th <br />HarrisonStreet,17Floor,Oakland,CA94612,Attn:CustomerService;888.229.2472(phone); <br />415.778.7272(fax);andcustomerservice@wcirb.com(email).TheregulationscontainedintheUSRP <br />and ERP are available for public viewing through the WCIRB's website atwcirb.com. <br />(2)PolicyholderInformation.PursuanttoCaliforniaInsuranceCode(CIC)Section11752.6,uponwritten <br />request,youareentitledtoinformationrelatingtolossexperience,claims,classificationassignments,and <br />policycontractsaswellasratingplans,ratingsystems,manualrules,orotherinformationimpactingyour <br />premiumthatismaintainedintherecordsoftheWCIRB.ComplaintsandRequestsforActionrequesting <br />th <br />policyholderinformationshouldbeforwardedto:WCIRB,1901HarrisonStreet,17Floor,Oakland,CA <br />94612,Attn:CustodianofRecords.TheCustodianofRecordscanbereachedat415.777.0777(phone) <br />and 415.778.7272 (fax). <br />Form PN 04 99 01 I (02/22)Printed in U.S.A.Page1 of3 <br />Process Date: 08/17/24Policy Expiration Date:09/26/25 <br /> <br />