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POLICY HOLDER NOTICE - PAYROLL BILLING <br />T❑an❑yo❑for cEoosing T❑e ❑artford. Yo-r policy is on o-r payroll Filling met❑od. T❑e payroll EiIling met❑cd -Ses act❑al <br />payrolls receiEod tilro❑gEoEt t❑e policy period and a dended rate CS❑to determine premiEMs d❑e doming t❑e policy period. <br />To learn more aEoEt ❑bw yo-r premiEn is calcdated on t❑e payroll EiIling met❑od please Eisit❑ <br />EttDsit/www.tELmElartford.conVE]ended <br />Below are t❑e dended rateCS❑❑eing ESed for eac❑state and classification code on yoJ policy-] <br />State <br />Class Code <br />Blended Rate <br />Effecti::6 <br />2❑ 900 Balcones Dr., A-stin, <br />9063 <br />0.380000 <br />11/04/20211 <br />T❑ <br />411COSTA MESA, CA <br />8811D <br />2.220000 <br />11/04/20211 <br />3❑WOS❑8300 SA11TA <br />8811D <br />2.220000 <br />11/04/20211 <br />MO❑ICA BL❑D, WEST <br />❑OLLYWOOD, CA <br />1❑❑432 E TIERRAB❑E❑A <br />9063 <br />0.400000 <br />11/04/202❑ <br />L❑, SCOTTSDALE, All <br />Form G-4119-0 Printed in ❑.S.A. <br />© 2017, The Hartford <br />