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4tThe Hartford POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION Information Available to You A. Information Available from Us - Hartford Casualty Insurance Company :1 ❑ General ❑FOstions regarding yoi-ir policy s❑o:ld ❑ e directed to your Hartford Agent or Hartford Casualty Insurance Company 3600 Wiseman Blvd San Antonio, TX 78251 Telephone: (877) 287-1316 agency.services@thehartford.com www.thehartford.com I❑ Dividend Calculation. If tiffs is a participating policy :a policy on wiJc❑ a di:Jdend may DO paid Epon payment or non-payment of a diijdend, we s0aII pro:Jde a written e:])lanation to yo❑ tiFlat sets ford❑ tEe psis of tip di:Jdend calciFlation. T❑e e:])lanation will Da in clear, iEnderstandaiJe Iang0age and will eEpress tip di:ldend as a dollar amo❑ht and as a percentage of t e earned premiiErn for tEe policy year on w-Jc❑t❑e diddend is calcdated. :3❑ Claims Information. Pjs:ant to Sections 3C61 and 3::62 of t—e California La❑or Code, yo❑ are entitled to recei::6 information in oij claim files t0at affects yoj premiE n. Copies of docErnents will 00 s!—pplied at yob eEpense d❑ring reasona:Ae ❑F:8iness Eo❑rs. For claims cored Ender tiEis policy, we will estimate t0a :1timate cost of iEnsettled claims for statistical piposes eigEteen mont::8 after t❑e policy incomes effecti::0 and will report t❑ose estimates to tie WoriEorsECompensation Instance Rating Bjea❑of California :WCIRB❑no later t0an twenty month after tEle policy ❑ecomes effecti::0. T❑e cost of any settled claims will also Ele reported at t0at time. At twelEo- mont❑ interF:8Is t0ereafter, we will iodate and report to tip WCIRB tEe estimated cost of any iEnsettled claims and t0e actual final cost of any claims settled in tip interim. T❑e amoEnts we report will Da iced ❑y tip WCIRB to compEle yoEr e:A)erience modification if yo❑ are eligiiJe for e:A)erience rating. B. Information Available from the Workers' Compensation Insurance Rating Bureau of California :1 ❑ T❑e WCIRB is a licensed rating organii:ation and ti—e California Instance Commissioners designated statistical agent. As s:Pq ti—e WCIRB is responsi:Ae for administering ti—e California Workers' Compensation Uniform Statistical Reporting Plan-1995 iii]SRP❑ and tEe California Workers' Compensation Experience Rating Plan-1995 LERP❑ WCIRB contact information isi❑ WCIRB, One Montgomery Street, SiJte 400, San Francisco, CA 94104, Attn❑C::8tomer Serucei❑B88.229.24E2 :P❑onei ii 41❑.❑❑8.22 :a=and c::8tomerser7ce❑ wcir❑.com Cemail❑ T❑e regFlations contained in t❑e ❑SRP and ERP are ai:ailaE]e for p❑lic mewing t❑ro-g❑tip WCIRI38 we::8ite at wcir-1com. _2❑ Policyholder Information. PjsiEant to California Instance Code !SIC❑Section 11 ❑2.6, iDpon written re❑!-iest, yo❑are entitled to information relating to loss ei-A)erience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manLiaI r!Fles, or ot❑ er information impacting yos premi::n t!1at is maintained in tie records of tie WCIRB. Complaints and Re❑❑ests for Action re❑sting policy older information s❑o:ld DO forwarded to❑WCIRB, One Montgomery Street, SJte 400, San Francisco, CA 94104, Attn❑ CC78todian of Records. T❑e Ci�todian of Records can Lie reaci-led at 41 ::I❑❑❑.0❑❑❑ iEu::One❑and 41 iEFiEB.22 Elam :30 Experience Rating Form. Eac❑e:A)erience rated ris❑may receii[o a single copy of its c:l-rent ExEperience Rating Form/WoriESEeet free of Clarge ❑y completing a Policy❑older E:A)erience Rating Wor-8:10et Rei❑❑est Form on tip WCIRB8 we::8ite at wciri!com/rates:10et. TOO E:A)erience Rating Form/Wor-8:10et will incl❑de a Loss -Free Rating, w::Jc❑ is tEe eL])erience modification tiFlat word EOE0 Deen calcElated if Form PN 04 99 01 J (06/25) Printed in 0-S.A. Process Date: 11/04/20 Page 1 of 3 Policy Expiration Date: 11/04/26