CRASIF - Premium Statement

July 1, 2023 to June 30, 2024

 

 


 

MEMBER Date Billed: 11/10/2023

Third Quarter Premium Statement No: CRA0000000

 

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