Filing At A Glance - AM Best Company
SERFF Tracking #: LWCM-129244251State Tracking #: LWCM-129244251State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsProduct Name:Comm AutoCompany Tracking #: CI-AUR-CW-001-13First Filing Company:Employers Insurance Company of Wausau, .Project Name/Number: ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13Filing at a GlanceCompanies:Employers Insurance Company of WausauWausau Underwriters Insurance CompanyWausau Business Insurance CompanyLiberty Mutual Insurance CompanyLiberty Mutual Fire Insurance CompanyLM Insurance CorporationThe First Liberty Insurance CorporationLiberty Insurance CorporationWausau General Insurance CompanyComm AutoIllinois20.0 Commercial Auto20.0000 Commercial Auto CombinationsRF3 - Summary Sheet 9244251Product Name:State:TOI:Sub-TOI:Filing Type:Date Submitted:SERFF Tr Num:SERFF Status:State Tr Num:State Status:Co Tr Num:CI-AUR-CW-001-13Effective DateRequested (New):Effective DateRequested (Renewal):Author(s):Reviewer(s):Disposition Date:Disposition Status:Effective Date (New):Effective Date (Renewal):02/01/201402/01/2014Lori Hartleben, Jill SchroederDee Caruso (primary)10/17/2013Accepted02/01/201402/01/2014PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM
SERFF Tracking #: LWCM-129244251State Tracking #: LWCM-129244251State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsProduct Name:Comm AutoCompany Tracking #: CI-AUR-CW-001-13First Filing Company:Employers Insurance Company of Wausau, .Project Name/Number: ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13General InformationProject Name: ADOPTION OF ISO 2013 MULTISTATE REVAND ISO ZONE-RATED COVSProject Number: CI-AUR-CW-001-13Reference Organization:Reference Title:Filing Status Changed: 10/17/2013State Status Changed:Created By: Jill SchroederCorresponding Filing Tracking Number:Status of Filing in Domicile:Domicile Status Comments:Reference Number:Advisory Org. Circular:Deemer Date:Submitted By: Jill SchroederFiling Description:RE:COMMERCIAL AUTOMOBILEISO 2013 MULTISTATE REVISIONS RULES –CA-2012-RADRU ANDLOSS COSTS – CA-2012-RADLCISO ADOPTION OF ZONE-RATED COVERAGESMANUAL RULES CA-2012-RZR1LOSS COSTS CA-2012-RZRLCCOMPANY EXCEPTION PAGESProject # CI-AUR-CW-001-13Liberty Mutual Insurance CompanyNAIC-0111-23043Liberty Mutual Fire Insurance CompanyNAIC-0111-23035LM Insurance CorporationNAIC-0111-33600The First Liberty Insurance CorporationNAIC-0111-33588Liberty Insurance CorporationNAIC-0111-42404Employers Insurance Company of WausauNAIC-0111-21458Wausau Underwriters Insurance CompanyNAIC-0111-26042Wausau Business Insurance CompanyNAIC-0111-26069Wausau General Insurance Company NAIC-0111-26425The captioned companies submit this filing to adopt Insurance Services Office Revisionslisted above.For Employers Insurance Company of Wausau, Wausau Underwriters Insurance Company,Wausau Business Insurance Company and Wausau General Insurance Company, we are filing new and revised companyexception pages for ISO rules to align with the ISO 2013 multistate revisions.For Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company, LM Insurance Corporation, The First LibertyInsurance Corporation, and Liberty Insurance Corporation, we are filing new and revised company exception pages for ISOrules to align with the ISO 2013 multistate revisions.PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM
SERFF Tracking #: LWCM-129244251State Tracking #: LWCM-129244251State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsProduct Name:Comm AutoCompany Tracking #: CI-AUR-CW-001-13First Filing Company:Employers Insurance Company of Wausau, .Project Name/Number: ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13We are also replacing our company exception page for Rule 98 to revise the company deductible factors for Zone Rated Autosto be equal to the current approved Company Factors for Trucks, Tractors and Trailer to align with the ISO revision which ismaking this change for their deductible factors.We are requesting an effective date of February 1, 2014 for new and renewal business.Please direct all questions regarding this filing to me at the address shown below.Please approve/ acknowledge this filing.Jill SchroederProduct Support ServicesLiberty Mutual InsurancePO BOX 8070Wausau WI 54402-8070(877) 792-8728 Ext. 8922Fax: (715) 842-6177Jilla.schroeder@libertymutual.comCompany and ContactFiling Contact InformationJill Schroeder, Product TechnicianPO BOX 8070Wausau, WI -8728 [Phone] 8922 [Ext]715-842-6828 [FAX]PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM
SERFF Tracking #: LWCM-129244251State Tracking #: LWCM-129244251State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsProduct Name:Comm AutoCompany Tracking #: CI-AUR-CW-001-13First Filing Company:Employers Insurance Company of Wausau, .Project Name/Number: ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13Filing Company InformationEmployers Insurance Company ofWausauPO BOX 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 21458Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 39-0264050State of Domicile: WisconsinCompany Type:State ID Number:Wausau Underwriters InsuranceCompanyPO BOX 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 26042Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 39-1341459State of Domicile: WisconsinCompany Type:State ID Number:Wausau Business InsuranceCompanyPO BOX 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 26069Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 36-3522250State of Domicile: WisconsinCompany Type:State ID Number:Liberty Mutual Insurance CompanyPO BOX 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 23043Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 04-1543470State of Domicile:MassachusettsCompany Type:State ID Number:Liberty Mutual Fire InsuranceCompanyPO Box 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 23035Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 04-1924000State of Domicile: WisconsinCompany Type:State ID Number:LM Insurance CorporationPO Box 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 33600Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 04-3058504State of Domicile: IllinoisCompany Type:State ID Number:The First Liberty InsuranceCorporationPO Box 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 33588Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 04-3058503State of Domicile: IllinoisCompany Type:State ID Number:PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM
SERFF Tracking #: LWCM-129244251State Tracking #: LWCM-129244251State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsProduct Name:Comm AutoCompany Tracking #: CI-AUR-CW-001-13First Filing Company:Employers Insurance Company of Wausau, .Project Name/Number: ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13Liberty Insurance CorporationPO BOX 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 42404Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 03-0316876State of Domicile: IllinoisCompany Type:State ID Number:Wausau General InsuranceCompanyPO Box 8070Wausau, WI 54402-8070(877) 792-8728 ext. [Phone]CoCode: 26425Group Code: 111Group Name: Liberty MutualInsuranceFEIN Number: 36-2753986State of Domicile: WisconsinCompany Type:State ID Number:Filing FeesFee Required?NoRetaliatory?NoFee Explanation:State SpecificRefer to our checklists prior to submitting filing (http://insurance.illinois.gov/Prop Cas IS3 Checklists/IS3 Checklists.asp ).:complyRefer to our updated (04/06/2007) SERFF General Instructions prior to submitting filing. They have been updated to clarifywhat rates and rules are required to be filed as well as what rates and rules are not required to be filed. Also, the "ProductName" is the Filing Title and not the Project Number.: complyNO RATES and/or RULES ARE REQUIRED TO BE FILED FOR LINES OF COVERAGE SUCH AS COMMERCIAL AUTO(except taxicabs), BURGLARY AND THEFT, GLASS, FIDELITY, SURETY, COMMERCIAL GENERAL LIABLITY, CROPHAIL, COMMERCIAL PROPERTY, DIRECTORS AND OFFICERS, ERRORS AND OMMISSIONS, COMMERCIAL MULTIPERIL just to mention a few. However, a Summary Sheet (RF-3) is required to be filed. Please refer to the State Specific Fieldbelow for what rates/rules are required to be filed and to our checklists for specific statutes, regulations, etc. :http://insurance.illinois.gov/Prop Cas IS3 Checklists/IS3 Checklists.asp .: complyMedical Malpractice rates/rules may now be submitted using SERFF effective January 1, 2012.: naThe only rates and/or rules that are required to be filed are Homeowners, Mobile Homeowners, Dwelling Fire and Allied Lines,Workers' Compensation, Liquor Liability, Private Passenger Automobiles, Taxicabs, Motorcycles and Group Inland MarineInsurance which only applies to insurance involving personal property owned by, being purchased by or pledged as collateralby individuals, and not used in any business, trade or profession per Regulation Part 2302 which says in part, "each companyshall file with the Director of Insurance each rate, rule and minimum premium before it is used in the State of Illinois.": complyWhen selecting a form filing type for a multiple form filing, use the dominant type from these choices: APP - application; CER certificate; COF - coverage form; DPS - declaration page; END - endorsement; POJ - policy jacket; ORG - Companiesadopting an Advisory or Rating Organization's filing. Example: If you are submitting a policy as well as endorsements, adeclaration page and an application, you would select "POL" for policy.: RF-3PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM
SERFF Tracking #:LWCM-129244251State Tracking #:LWCM-129244251Company Tracking #:State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsFirst Filing Company:Product Name:Comm AutoProject Name/Number:ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13CI-AUR-CW-001-13Employers Insurance Company of Wausau, .Correspondence SummaryDispositionsStatusCreated ByCreated OnDate SubmittedAcceptedDee Caruso10/17/201310/17/2013PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM
SERFF Tracking #:LWCM-129244251State Tracking #:LWCM-129244251Company Tracking #:State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsFirst Filing Company:Product Name:Comm AutoProject Name/Number:ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13CI-AUR-CW-001-13Employers Insurance Company of Wausau, .DispositionDisposition Date: 10/17/2013Effective Date (New): 02/01/2014Effective Date (Renewal): 02/01/2014Status: AcceptedComment:Overall %IndicatedChange:Overall %RateImpact:Written PremiumChange forthis Program:# of PolicyHolders Affectedfor this Program:WrittenPremium forthis Program:Maximum %Change(where req'd):Minimum %Change(where req'd):Employers InsuranceCompany of Wausau0.000%0.000% 027 235,3960.000%0.000%Wausau UnderwritersInsurance Company0.000%-0.400% -5,836168 1,389,1530.000%0.000%Wausau BusinessInsurance Company0.000%0.000% 010 47,0270.000%0.000%Liberty Mutual Insurance 0.000%Company0.000% 022 284,1350.000%0.000%Liberty Mutual FireInsurance Company-0.500% -58,988380 11,264,3820.000%0.000%LM Insurance Corporation 0.000%0.000% 09 122,3240.000%0.000%The First LibertyInsurance Corporation0.000%-0.100% -51637 425,0110.000%0.000%Liberty InsuranceCorporation0.000%0.000% 045 474,6530.000%0.000%Wausau GeneralInsurance Company0.000%0.000% 00 00.000%0.000%CompanyName:0.000%PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM
SERFF Tracking #:LWCM-129244251State Tracking #:LWCM-129244251Company Tracking #:State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsFirst Filing Company:Product Name:Comm AutoProject Name/Number:ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13Overall Rate Information for Multiple Company FilingsOverall Percentage Rate Indicated For This FilingOverall Percentage Rate Impact For This FilingEffect of Rate Filing-Written Premium Change For This ProgramEffect of Rate Filing - Number of Policyholders AffectedCI-AUR-CW-001-13Employers Insurance Company of Wausau, .0.000%-0.500% -65,340698ScheduleSchedule ItemSchedule Item StatusSupporting DocumentForm RF3 - (Summary Sheet)YesSupporting DocumentRequest to Maintain Data as Trade Secret InformationYesSupporting DocumentInventoryYesRateRule 49. Auto Dealers - Premium DevelopmentYesRateRule 50. Auto Dealers - Additional ProvisionsYesRateRule 55. Garagekeepers' Insurance - PremiumDevelopmentYesRateRule 98. Deductible InsuranceYesRateRule 103. Pollution Liability (Class Code 7971)YesRateCO-AC 25 01 10 13YesPDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AMPublic Access
SERFF Tracking #:LWCM-129244251State Tracking #:LWCM-129244251Company Tracking #:State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsFirst Filing Company:Product Name:Comm AutoProject Name/Number:ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13CI-AUR-CW-001-13Employers Insurance Company of Wausau, .Rate InformationRate data applies to filing.Use & FileFiling Method:Rate Change Type:Overall Percentage of Last Rate Revision:Effective Date of Last Rate Revision:Filing Method of Last Filing:Decrease2.600%10/01/2013Use & FileCompany Rate InformationOverall %IndicatedChange:Overall %RateImpact:Written PremiumChange forthis Program:# of PolicyHolders Affectedfor this Program:WrittenPremium forthis Program:Maximum %Change(where req'd):Minimum %Change(where req'd):Employers InsuranceCompany of Wausau0.000%0.000% 027 235,3960.000%0.000%Wausau UnderwritersInsurance Company0.000%-0.400% -5,836168 1,389,1530.000%0.000%Wausau BusinessInsurance Company0.000%0.000% 010 47,0270.000%0.000%Liberty Mutual Insurance 0.000%Company0.000% 022 284,1350.000%0.000%Liberty Mutual FireInsurance Company-0.500% -58,988380 11,264,3820.000%0.000%LM Insurance Corporation 0.000%0.000% 09 122,3240.000%0.000%The First LibertyInsurance Corporation0.000%-0.100% -51637 425,0110.000%0.000%Liberty InsuranceCorporation0.000%0.000% 045 474,6530.000%0.000%CompanyName:0.000%PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM
SERFF Tracking #:LWCM-129244251State Tracking #:LWCM-129244251Company Tracking #:State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsFirst Filing Company:Product Name:Comm AutoProject Name/Number:ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13Wausau GeneralInsurance Company0.000%0.000% 00CI-AUR-CW-001-13Employers Insurance Company of Wausau, . 0PDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AM0.000%0.000%
SERFF Tracking #:LWCM-129244251State Tracking #:LWCM-129244251Company Tracking #:State:IllinoisTOI/Sub-TOI:20.0 Commercial Auto/20.0000 Commercial Auto CombinationsFirst Filing Company:Product Name:Comm AutoProject Name/Number:ADOPTION OF ISO 2013 MULTISTATE REV AND ISO ZONE-RATED COVS/CI-AUR-CW-001-13CI-AUR-CW-001-13Employers Insurance Company of Wausau, .Rate/Rule ScheduleItemNo.Schedule ItemStatusExhibit NameRule # or Page #Rate ActionPrevious StateFiling Number1Rule 49. Auto Dealers Premium Development1st Edition 11 11WithdrawnCM-AUR-CW-076-102Rule 50. Auto Dealers Additional Provisions1st Edition 10 13New3Rule 55. Garagekeepers'Insurance - PremiumDevelopment2nd Edition 10 13ReplacementCM-AUR-CW-076-10 LC55 AUTO MU 1013.pdf4Rule 98. DeductibleInsurance4th Edition 01 14ReplacementCM-AUR-IL-032-115Rule 103. Pollution Liability(Class Code 7971)2nd Edition 10 13ReplacementCM-AUR-CW-009-12 RU103 AUTO MU 1013POLLUTION LIABILITY.pdf6CO-AC 25 01 10 131st Edition 10 13NewAttachmentsRU50 AUTO MU 1013.pdfPDF Pipeline for SERFF Tracking Number LWCM-129244251 Generated 10/23/2013 09:24 AMRU98 AUTO MU 0114.pdfAuto Dealers EnhancementEndorsement Pricing Rule(4).pdf
COMMERCIAL LINES MANUALDIVISION ONEAUTOMOBILECOMPANY EXCEPTIONRULE 50. AUTO DEALERS – ADDITIONAL PROVISIONSParagraph B.4. is revised to:To provide coverage for defense expenses only arising out of the sale, service or repair of an auto in the namedinsured's auto dealer operations, use Customer Complaint Legal Defense Coverage Endorsement CA 25 66.Charge 4% of the Auto Dealers Liability Premium.Class Code 7070st1 Edition 10-13 2013 Liberty Mutual Insurance. All rights reserved.Includes copyrighted material of Insurance Services Office, Inc.,with its permission.Page 1 of 1
COMMERCIAL LINES MANUALDIVISION ONEAUTOMOBILELOST COST PAGESCOMPANY EXCEPTION55. GARAGEKEEPERS' INSURANCE – PREMIUM DEVELOPMENTGARAGEKEEPERS' – COLLISIONFor additional coverages, refer to company is replaced by the following:To provide higher deductibles, multiply the 500 collision deductible loss cost by the following factors:For additional coverages, refer to company.2ndEdition 10 13 1,000 deductible – Multiply the above by .86. 2,000 deductible – Multiply the above by .66. 2,500 deductible – Multiply the above by .58. 3,000 deductible – Multiply the above by .52. 4,000 deductible – Multiply the above by .43. 5,000 deductible – Multiply the above by .36. 10,000 deductible – Multiply the above by .34. 2013 Liberty Mutual Insurance. All rights reserved.Page 1 of 1
COMMERCIAL LINES MANUALDIVISION ONEAUTOMOBILEEXCEPTION PAGESCOMPANY EXCEPTION98. DEDUCTIBLE INSURANCEThe following factors are .930Table 98.B.1.b.(1)(a) Private Passenger Types Comprehensive Deductible 0.650Table 98.B.1.b.(1)(b) Trucks, Tractors And Trailers And All Autos Except Zone-rated Risks ComprehensiveDeductible 0.900Table 98.B.1.b.(2)(a) Private Passenger Types Collision Deductible .9401.0001.040Table 98.B.1.b.(2)(b) Trucks, Tractors And Trailers And All Autos Except Zone-rated Risks Collision DeductibleFactorsth4 Edition 01 14 2013 Liberty Mutual Insurance. All rights reservedPage 1 of 2
COMMERCIAL LINES MANUALDIVISION ONEAUTOMOBILEEXCEPTION PAGESCOMPANY EXCEPTION98. DEDUCTIBLE INSURANCE .6300.650Table 98.B.2.b.(1) Zone-rated Risks Comprehensive Deductible .9401.0001.040Table 98.B.2.b.(2) Zone-rated Risks Collision Deductible Factors3.Auto Dealers Blanket CollisionThe following information is added:To provide higher deductibles, multiply the 250 deductible collision coverage premium by the appropriate factor:Deductible 2,000 2,500 3,000 4,000 5,000 10,0004.Factor.33.325.32.31.30.295Auto Dealers And Garagekeepers Insurance Other Than CollisionThe following information is added:Per Auto And Per OccurrenceDeductible Options 2,500/ 3,000/ 4,000/12,50015,00020,000N/AN/AN/A.61.59.55 1,000/ 2,000/ 5,000/ 10,000/Coverage5,00010,00025,00050,000Fire OnlyN/AN/AN/AN/AFire and Theft O
State of Domicile: Illinois Company Type: State ID Number: The First Liberty Insurance Corporation PO Box 8070 Wausau, WI 54402-8070 (877) 792-8728 ext. [Phone] CoCode: 33588 Group Code: 111 Group Name: Liberty Mutual Insurance FEIN Number: 04-3058503 State of Domicile:
Medical Malpractice Liability Rate/Rule Contact Person: Keith Fanning (217) 782-1792 Line(s) of Insurance/Business: . filing code 11.0030 Dentists – General Practice; filing code 11.0006 Dentists – Oral Surgeon; filing code 11.0007 . filing code 11.0015 Nursing Homes; filing code 11.0016 Occupational Therapy; filing code .
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Filing at a Glance Company: Group Health Incorporated Product Name: GHI OFF Exchange Sm Grp State: New York TOI: H15G Group Health - Hospital/Surgical/Medical Expense Sub-TOI: H15G.003 Small Group Only Filing Type: Off Exchange NG Forms & Rates Date Submitted: 05/30/2013 SERFF Tr Num: GRPH-
Filing at a Glance Company: AAA Life Insurance Company Product Name: New Benefit Levels for Member Loyalty Travel Accident Insurance State: District of Columbia TOI: H02G Group Health - Accident Only Sub-TOI: H02G.000 Health - Accident Only Filing Type: Rate Date Submitted: 09/24/2013 SERFF
Filing at a Glance Company: Providence Health Plan Product Name: 90-day Discontinuance Filing_Providence_Portability_123113 State: Oregon TOI: H06 Health - Conversion Sub-TOI: H06.000 Health - Conversion Filing Type: Form Date Submitted: 08/16/2013 SERFF Tr Num: PROV-129121711 SERFF Status: Closed-Filed
Project Name: Homeowners Rate Revision Status of Filing in Domicile: Not Filed Project Number: HCA0703-105800 Domicile Status Comments: . Company Name Company Name Company Name NAIC Company Code CDI Filing No. ( Department use only ) NAIC Company Code CDI Filing No. (
