**THE HARTFORD**

**Policy Number:** 10 HU SG6756

This endorsement forms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE GROUP company designated therein, and takes effect as of the effective date of said policy unless another effective date is stated herein.

**Effective Date:** Effective hour is the same as stated in the Declarations of the policy.

**Endt. No:** 17

**Premium Computation Endorsement**

It is agreed that the premium for the above caption policy shall be computed as follows:

| Estimated Annual Receipts/Sales | Rate Per $1000 of Sales | Premium |
|----------------------------------|------------------------|---------|
| $52,300,000,000                  | .016                   | $833,000 |

It is agreed, however, that no premium adjustment additional premium will be charged unless the audited sales/receipts exceed ten percent of the estimated sales/receipts shown above.

**Minimum Premium:** $833,000

The Minimum Premium is a flat deposit premium for the above estimated sales. The rate shall be applied once the estimated sales have been exceeded. If PRO-RATA CANCELLATION: Both the M.P. and the annual receipts will be pro-rated. The rate then will be applied to the sales which exceed the pro-rata figure.

Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.

This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.

Form G-2240-3 B Printed in USA

Countersigned by: ___________________________

Authorized Agent