MEMBER NAME

Loc#	Code	Classification	Payroll Estimate	Rate per $100 of Payroll	Manual Premium	Experience Modification Factor	Standard Premium
5506		Heavy Maintenance	$ -	14.43	$ - $ -
5509		Street Maintenance	$ -	3.46	$ - $ -
8227		Contractors Yard	$ -	2.02	$ - $ -
8810		Clerical	$ -	0.60	$ - $ -
9410		Municipal Employees	$ -	0.76	$ - $ -

TOTAL $ - $ - $ -

2023 Dividend Premium Discount

Net Annual Discounted Premium $ -

Less: Payments to Date $ -

Balance Owed through June 30, 2024 $ -

Due on December 10, 2023

NOTE:

1. The 3rd quarterly deposit is due by December 10, 2023 for January 1, 2024 to March 31, 2024.

2. Please forward only your check to the lockbox. Do not send a check stub or copy of invoice with the payment.

3. Please make check payable and return to:

Text Box: COUNTY ROAD ASSOCIATION SELF-INSURANCE FUND Dept #771839
P.O. Box 77000 Detroit, MI. 48277-1839