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1-The Hartford <br /> 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 to your Hartford Agent or <br /> Hartford Casualty Insurance Company <br /> 3600 Wiseman Blvd <br /> San Antonio,TX 78251 <br /> Telephone: (877) 287-1316 <br /> agency.services@thehartford.com <br /> www.thehartford.com <br /> (2) Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon <br /> payment or non-payment of a dividend, we shall provide a written explanation to you that sets forth the <br /> basis of the dividend calculation. The explanation will be in clear, understandable language and will <br /> express the dividend as a dollar amount and as a percentage of the earned premium for the policy year <br /> on which the dividend is calculated. <br /> (3) Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled <br /> to receive information in our claim files that affects your premium. Copies of documents will be supplied at <br /> your expense during reasonable business hours. <br /> For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical <br /> purposes eighteen months after the policy becomes effective and will report those estimates to the <br /> Workers' Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after <br /> the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve- <br /> month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled <br /> claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by <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) The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated <br /> statistical agent. As such, the WCIRB is responsible for administering the California Workers' <br /> Compensation Uniform Statistical Reporting Plan-1995 (USRP) and the California Workers' <br /> Compensation Experience Rating Plan-1995 (ERP). WCIRB contact information is: WCIRB, One <br /> Montgomery Street, Suite 400, San Francisco, CA 94104, Attn: Customer Service; 888,229.2472 (phone); <br /> 415.773.7272 (fax); and customerservice wcirb.com (email). The regulations contained in the USRP <br /> and ERP are available for public viewing through the WCIRB's website at wcirb.com, <br /> (2) Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written <br /> request, you are entitled to information relating to loss experience, claims, classification assignments, and <br /> policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your <br /> premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting <br /> policyholder information should be forwarded to: WCIRB, One Montgomery Street, Suite 400, San <br /> Francisco, CA 94104, Attn: Custodian of Records. The Custodian of Records can be reached at <br /> 415.777.0777 (phone)and 415.778.7272 (fax). <br /> (3) Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience <br /> Rating FormlWorksheet free of charge by completing a Policyholder Experience Rating Worksheet <br /> Request Form on the WCIRB's website at wcirb.com/ratesheet. The Experience Rating Form/worksheet <br /> will include a Loss-Free Rating, which is the experience modification that would have been calculated if <br /> Form PN 04 99 01 J (06/25) Printed in U.S.A. Page 1 of 3 <br /> Process Date: 11/04/25 Policy Expiration Date: 11/04/26 <br />