Exhibit 10.4
Agreement made this day of , 200 between Insurance Services Office, Inc., with
offices at 000 Xxxxxxxxxx Xxxxxxxxx, Xxxxxx Xxxx, Xxx Xxxxxx 00000-0000 on behalf of itself, its
subsidiaries and affiliates (“ISO”®) and having offices at
and all its affiliates and subsidiaries that provide property/casualty
insurance, unless excluded on an attached Schedule A (collectively referred to herein as
“Licensee”).
In consideration of the mutual covenants contained herein, the parties agree as follows:
a. “Agreement” means this agreement and all Exhibits, Annex(es) and Supplement(s).
b. “Confidential Information” means any non-public information of either party including but not
limited to, agenda and minutes of ISO panels.
c. “Product” or “Products” means any and all works, materials, and data, distributed by ISO or by a
third party licensor of ISO, in any form, format or media (including but not limited to paper,
electronic media and all forms of electronic delivery) including but not limited to manuals, forms
and endorsements, circulars, actuarial studies, loss costs, statistical plans, database outputs,
data compilations and software, and their derivatives that are proprietary to and/or copyrighted or
copyrightable by ISO or proprietary to and/or copyrighted or copyrightable by a third party
licensor of ISO and lawfully licensed to ISO for distribution by ISO and are applicable to the
services and jurisdictions for the lines of insurance or subdivisions thereof, as indicated in the
Supplements.
d. “Supplements” means the Participation Supplement for each line of insurance (the
“Participation Supplements”) and all Product Supplements attached to this Agreement and
incorporated by reference herein.
e. “Territory” The states, jurisdictions or territories of the United States of America, as
licensed herein.
a. To the extent indicated by Licensee on any Participation Supplement, Licensee agrees to
participate with ISO as defined in ISO’s Certificate of Incorporation and By-laws and as set out in
the Participation Supplements. Licensee agrees to abide by any rules or procedures duly adopted by
the Board of Directors of ISO as they apply to ISO participation and this Agreement. Licensee will
be promptly notified of and provided with any modifications or updates to said rules or procedures.
Licensee acknowledges that it is not required to license or use any Product filed or issued by
ISO, except as may be required by law or regulation, and Licensee shall not state or in any way
suggest or represent to any entity that it is or has been required to do so.
b. By selecting participation for Statistical Agent Service in the Participation Supplement,
Licensee agrees to report its statistical data to ISO in accordance with ISO’s applicable
statistical plans, calls for statistics and related requirements. Licensee agrees that ISO has the
right to use said data in developing loss costs and other products, provided that such use does not
reveal Licensee’s individual information.
Provided that Licensee:
a. has completed the appropriate Participation Supplement(s) and/or all applicable Product
Supplement(s); and
b. continues to abide by the terms of this Agreement and the Supplements for the services,
Territory and lines of insurance, or subdivisions thereof, pertaining to the Products licensed
hereunder;
ISO grants to Licensee a non-exclusive, non-transferable license to use in the Territory the
Products which are obtained directly from ISO, or from a third party licensed by ISO to distribute
them to Licensee, solely for Licensee’s property/casualty insurance or reinsurance business.
Licensee may copy or reproduce the Product(s) at its premises as permitted in Section 6 below, but
may not use a third party to do so unless that third party is licensed by ISO to supply the
Product(s) and Licensee has confirmed with ISO that the third party is, in fact, licensed to do so.
Except as may be permitted under Sections 5. and 6. of this Agreement or under any Supplement to
this Agreement, Licensee agrees to restrict access to all Products only to those employees of
Licensee who have a need to use them solely for purposes of Licensee’s property/casualty insurance
or reinsurance business (“authorized employees”). Access to some Products may be limited to
certain employees or other authorized users as identified on the Product Supplement. Except as may
be specifically permitted herein, neither Licensee, nor its employees, nor any users authorized by
the Supplements, shall sell, transfer, distribute, publish, disclose, display or otherwise make the
Product(s) or any of the information therein available, in whole or in part, to any other person or
entity, without the express written consent of ISO.
For the sole purpose of verifying Licensee’s compliance with this Agreement, ISO may require, on
at least ten (10) days prior notice, an examination and copying of any and all information, books
of account, records, documents, operations and other materials under the control of the Licensee,
and other related entities, which contain records of Licensee’s use of the Products in accordance
with this Agreement. All such documents shall be kept available by Licensee for at least three
(3) years after the period to which they relate. ISO may exercise this right once in any twelve
(12) month period. The audit will be conducted by ISO or its authorized representatives.
In the event Licensee fails to satisfy any of the conditions specified above, ISO may immediately
cease providing Products to Licensee and may terminate access to the Products and thereafter
notify Licensee of same.
This Agreement is effective on the date specified above and shall remain in force until terminated.
a. ISO may terminate this Agreement and/or any Supplement(s) as follows:
(1) if Licensee materially violates any term or condition of this Agreement or any
Supplement(s) and fails to cure said violation within thirty (30) days following receipt of
notice thereof from ISO. In such event, ISO may cease providing the Product(s) to Licensee
unless and until Licensee cures said breach; or
(2) if Licensee defaults in the payment of any fee(s) due under this license with ten (10)
days prior notice ; or
(3) if ISO makes a business decision to discontinue any Product(s) and/or the maintenance
and support of any Product(s) licensed hereunder, provided, however, that ISO shall provide
Licensee with at least ninety (90) days notice of any such discontinuance, and Licensee may
continue to use the discontinued Product subject to the provisions of section 4.e. below; or
(4) if ISO makes a business decision to discontinue participation for any line of insurance,
or subdivision thereof, Territory or service, provided, however, that ISO shall provide
Licensee with at least one hundred eighty (180) days notice of any such discontinuance; or
(5) upon the effective date of legislation, regulation or judicial ruling or decision
requiring ISO to discontinue participation for any line of insurance, or subdivision
thereof, Territory or service, or discontinue providing any Product(s); or
(6)immediately if Licensee (i) terminates or suspends its business; (ii) becomes subject to
any bankruptcy or insolvency proceeding under federal or state law; or (iii) becomes
insolvent or becomes subject to direct control by a trustee, receiver or similar authority;
or
(7) for any other reason, upon one hundred eighty (180) days written notice to Licensee.
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Licensee may terminate any Participation Supplement, or portion thereof, effective at the
end of a calendar quarter by providing ISO with sixty (60) days written notice prior to end of
the quarter. |
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Licensee may terminate this agreement and any Product Supplement, or portion thereof: |
(1) if ISO terminates or suspends its business; or
(2) if ISO becomes subject to any bankruptcy or insolvency proceeding under federal or state
law; or
(3) if ISO becomes insolvent or becomes subject to direct control by a trustee, receiver or
similar authority; or
(4) for any other reason, upon one hundred eighty (180) days written notice to ISO.
d. In the event of termination including expiration of this Agreement or any Supplements, ISO shall
have the right to cease providing Products to Licensee and terminate Licensee’s access to
Product(s), and Licensee shall immediately discontinue use of the Products, and at ISO’s option:
(1) return to ISO all applicable Products provided, including all manuals, associated
documentation and any copies thereof; or
(2) destroy the applicable Products, including all manuals, associated documentation and any
copies thereof; and
(3) certify in writing signed by an officer of Licensee that they have been so returned or
destroyed.
e. ISO may, in certain circumstances and at its sole discretion, decide to permit Licensee to
continue to use a Product during a transition period (specified below) after the termination of
this Agreement in its entirety or a termination of that portion of this Agreement applicable to
that Product. If Licensee requests such permission, and ISO agrees, then Licensee must:
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(1) execute an ISO Transitional License; and
(2) pay all Transition License fees.
Licensee acknowledges and understands that during the transition period, which shall not
exceed three (3) years, Licensee shall not be licensed to use any update to any terminated
Product(s) nor shall Licensee receive any maintenance or other services related to the
terminated Product(s). If Licensee executes a Transitional License, and pays the
appropriate fees, Licensee shall not be required to return or destroy the Product(s), as
required under section 4.d., until the expiration or termination of the Transition License.
f. Termination under this Section 4. shall not relieve Licensee of its obligations to ISO regarding
participation for the period during which such participation existed or regarding property or
copyright as specified in Sections 2., 9. and 10. In the event of termination as a result of
Licensee’s breach of its obligations under this Agreement, Licensee shall continue to be obligated
for any payments due up to the effective date of termination.
g. If the license to use any Product provided to Licensee electronically is terminated by ISO under
Section 4.a.(1) or (2) or is terminated by Licensee, Licensee will be liable and charged for
payment of all applicable termination charges related thereto.
h. Termination of this Agreement and/or any Supplement(s) shall be in addition to and not in lieu
of any other remedies available to ISO.
5.
RESTRICTION AGAINST TRANSFER OF CONFIDENTIAL INFORMATION: Licensee shall not disclose
or release any ISO Confidential Information which is disclosed to Licensee either (i) in a writing
or other tangible form or (ii) orally, to any third party except with ISO’s prior written consent,
unless compelled to do so by legal process. In such case, Licensee shall give ISO reasonable and
sufficient notice to allow ISO to take action to protect its confidential information and trade
secrets. Licensee shall treat ISO Confidential Information in the same manner and with the same
protections and safeguards as Licensee protects and safeguards its own confidential information and
trade secrets.
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ISO agrees that statistical information provided by Licensee shall be considered Licensee’s
confidential information, and ISO shall not release any such information to any third party
without Licensee’s prior written consent, except to appropriate insurance regulators as part
of provision of statistical services (if such services are requested by Licensee), unless
compelled to do so by legal process. |
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ISO and Licensee acknowledge that much, if not all, of the material and information which has
or will come into their possession from the other party pursuant to this Agreement consists of
confidential and proprietary information, nonpublic personal information or software of the
disclosing party and its affiliates, agents, Licensees or third parties (“Confidential
Information”). The party receiving such Confidential Information agrees to hold it in
strictest confidence and agrees not to release or disclose such Confidential Information to
any individual or entity, whether employee, subcontractor, or subcontractor employee, except
that the receiving party may disclose such information to its employees who are necessarily
involved in the performance of the recipient’s obligations hereunder and have agreed in
writing to keep the information confidential to protect the disclosing party’s interests. |
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The party receiving Confidential Information further agrees not to (i) use the Confidential
Information for its own benefit or for the benefit of any third parties, other than for the
performance of its obligations under this Agreement, and (ii) release or disclose the
Confidential Information to any other entity, either during the term or after the termination
of this Agreement. In the event of any breach of this confidentiality obligation or of the
obligations relative to the rights to products and services pursuant to this Agreement, or any
product developed or delivered in providing Services, the party receiving the Confidential
Information acknowledges that the disclosing party may have no adequate remedy at law, since
the harm caused by such a breach could not be easily measured and compensated for in the form
of damages. |
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The party receiving the Confidential Information shall be solely responsible for maintaining
the security of such Confidential Information and for complying with all federal, state,
provincial and local laws, regulations, or other requirements including the Xxxxx-Xxxxx-Xxxxxx
Act of 1999, 15 U.S.C., Section 6801, as amended from time to time governing the privacy,
confidentiality and non-disclosure of such information. |
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The foregoing obligations shall not apply to any information which: a) is or becomes known
publicly through no fault of the receiving party; or b) is acquired or learned by the
receiving party from a third party entitled to disclose it; or c) is already known to the
receiving party before receipt from the disclosing party as shown by the receiving party’s
written records; or d) is independently developed by the receiving party, as shown by the
receiving party’s written records; or e) must be disclosed by operation of law. |
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The foregoing obligations of each party shall survive the termination or expiration of this
agreement. |
6.
RESTRICTION AGAINST COPYING OR REDISTRIBUTING THE PRODUCT(S): Except as otherwise
provided in this Agreement, the Product(s) licensed hereunder may not be copied, reproduced,
redistributed, sold, filed or used in any manner, without the written permission of ISO or, if the
Product or the portion thereof to be copied, distributed or used is proprietary to a third party,
the permission of that third party.
Licensee must receive ISO’s written permission prior to
making a Product(s) available in electronic
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format including but not limited to via the Internet, extranet, local area network, wide area
network or similar technology and Licensee agrees to pay any associated fees.
Subject to the above and any additional limitations identified below or in the Supplement(s),
permission is hereby granted to reproduce and redistribute copies and extracts of the Products and
the information therein:
a. in any format, to Licensee’s authorized employees;
b. in paper format only to Licensee’s insurance agents and insureds, solely for use in conjunction
with specific policies quoted and/or underwritten by Licensee;
c. in paper format only, to attorneys, independent claims adjusters, loss control consultants and
premium auditors, solely for use in conjunction with work being performed on Licensee’s behalf;
d. to all other consultants, vendors and other third parties, so long as the consultants, vendors
and third parties are licensed by ISO to use the Product solely to provide a product or service to
Licensee;
e. in any format, for the sole purpose of making a filing with insurance regulators, and related
regulatory matters.
Licensee agrees to comply with ISO’s security requirements associated with such availability of
Products. Licensee also agrees to reproduce ISO’s copyright notice, or any applicable third party’s
copyright notice, in any permitted copies, modifications or partial
copies of the
Product(s) that
Licensee makes.
To the extent Licensee wishes to distribute the Product(s), in whole or in part to any entity not
specifically listed in sections 6.a. through 6.e. above, Licensee must receive ISO’s prior written
permission. ISO may require Licensee to comply with specific security requirements and/or pay
additional fees as a condition of such permission.
Licensee agrees that, to the extent it modifies any Product(s), it is solely responsible for
ensuring that, if required, the modified Product(s) is approved by applicable insurance regulators
for Licensee’s use. Licensee further acknowledges that ISO is not required to provide services or
assistance with respect to modified Products, and that, if ISO agrees to provide such services or
assistance, Licensee may be required to pay consulting fees to ISO.
7. FEES:
Licensee agrees to pay ISO the following fees:
a. Participation Service Fees: Licensee agrees to pay ISO all fees invoiced for participation with
ISO, applicable to the services, Territories and lines of insurance or subdivisions thereof for
which Licensee’s ISO participation applies, as indicated in the Participation Supplement(s),
according to the policies and procedures set forth in the then-current edition of ISO’s
“Participation Billing” booklet.
b. Product Fees: Licensee agrees to pay ISO all fees invoiced for Products within thirty (30)
days of receipt of the invoice. Fees are nonrefundable unless otherwise indicated in writing. The
fee for the initial term for each Product licensed after the effective date of this Agreement is
indicated on the applicable Product Supplement. ISO reserves the right to amend the fees due on
prior notice to Licensee. Licensee shall have thirty (30) days from the date of any renewal notice
or notice of a change in fees to advise ISO in writing of its intent to make adjustments in its
order for the Product(s).
Licensee shall be responsible for payment of fees for all participation services and Products
licensed, regardless of whether Licensee actually uses any or all such Products or services. ISO
reserves the right to amend the fees due on prior notice to Licensee. Except for taxes based on
ISO’s income, Licensee shall be responsible for payment to ISO of all federal, state and local
sales, excise, use or similar taxes in connection with Licensee’s licensing or use of the
Product(s) licensed hereunder. Licensee shall pay ISO interest on all charges not paid within
thirty (30) days at the rate of one percent (1%) per month or the maximum interest permitted by
law, whichever is less.
If ISO terminates the Agreement, in whole or part, pursuant to Sections 4.a. (1) or (2) above, ISO
will reinstate distribution of and/or access to Product(s) only after Licensee pays all outstanding
charges, including any interest and administrative costs that ISO may impose, and all charges
incurred by ISO in disconnecting and reconnecting Licensee access to the Product(s), if applicable.
c. For any Product(s) which will be provided to Licensee electronically, Licensee, at Licensee’s
expense must: (i) provide all necessary Licensee equipment and appropriate interfacing devices; and
(ii) pay for all costs to connect to an ISO-provided connect point or designated node, if
necessary.
a. Licensee agrees to comply with the following security requirements for any Products licensed
hereunder.
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b. Licensee agrees that it will not attempt to circumvent any security measures contained within or
associated with any Product licensed hereunder. Licensee shall not attempt to decompile, reverse
engineer, or otherwise disassemble or obtain the source code of any Product provided hereunder.
c. To the extent a Product licensed hereunder is accessed electronically Third-party software,
sometimes called “spyware”, can infect a user’s computer and capture data without permission.
ISO is not responsible if any confidential data of Licensee or its agents is compromised in
this manner. In order to protect its own data, ISO reserves the right, without prior notice,
to suspend access to any ISO web application by any user or agent whose computer is infected in
this manner until the infection is removed. ISO will make reasonable efforts to notify the
Licensee beforehand, but circumstances may require prompt action.
9.
ACKNOWLEDGEMENT OF ISO INTELLECTUAL PROPERTY: Licensee acknowledges that ISO claims
ownership of and a copyright in the Products and shall not contest or dispute, and waives any
defense concerning, any valid ownership or copyright claim made by ISO in the Products. ISO is the
owner or authorized licensee of all proprietary information contained in the Products and has the
right to grant Licensee the license to use the Products in accordance with this Agreement without
violating any law, rule or regulation. Licensee agrees not to take any action that would in any
way impair, jeopardize, be inconsistent with, or violate ISO’s ownership of the Product(s) or any
valid ISO copyright. ISO’s claims of copyright relate to all Products provided to Licensee
pursuant to this Agreement, unless it is stated in the Supplement(s), or on the Product itself,
that a Product is copyrighted by or proprietary to a third party. All applicable rights to patents,
copyrights, trademarks and trade secrets in the Products, and any modifications made to the
Products, and in the information therein, shall remain in ISO or the applicable third party.
Licensee agrees that such third parties are third-party beneficiaries of this Agreement and are
entitled to enforce their rights hereunder against Licensee. Nothing in this Agreement shall be
construed as granting to Licensee any right, title or interest in or to any patent, trademark,
copyright or other right of ISO or the applicable third party. Licensee warrants and represents
that it will take all reasonable steps necessary to protect and preserve the Product(s) and the
interests and rights of ISO and any applicable third parties therein, including appropriate action
by instruction or agreement with its employees or other authorized users permitted access to the
Products.
a. If Product(s) are reprinted, copied or otherwise used in full, copies must reflect the copyright
notice actually shown on the Product(s).
b. If Product(s) are reprinted, copied or otherwise used in part, the following legend must appear
at the bottom of each page so used:
“Includes copyrighted material of Insurance Services Office, Inc. with its permission.” If the
material to be reprinted, copied or otherwise used is copyrighted by a third party, Licensee must
obtain permission of the copyright owner to so use the material, and abide by any requirements set
forth by the third party.
11.
LIMITATION ON WARRANTIES; NO LIABILITIES: OTHER THAN THOSE REPRESENTATIONS OR
WARRANTIES SPECIFICALLY SET FORTH HEREIN, ISO MAKES NO REPRESENTATIONS, COVENANTS OR WARRANTIES OF
ANY KIND, EITHER EXPRESS OR IMPLIED, WITH RESPECT TO THE PRODUCTS, INCLUDING BUT NOT LIMITED TO
WARRANTIES OF CONDITION, QUALITY, DURABILITY, SUITABILITY, MERCHANTABILITY OR FITNESS FOR A
PARTICULAR PURPOSE, OR IN RESPECT OF ANY WARRANTY ARISING BY STATUTE OR OTHERWISE IN LAW OR FROM A
COURSE OF DEALING OR USAGE OF TRADE. IF THE FOREGOING LIMITATION IS HELD TO BE UNENFORCEABLE,
ISO’S LIABILITY SHALL NOT EXCEED THE AMOUNT PAID TO ISO FOR THE LICENSE TO USE THE PRODUCT DURING
THE TWELVE MONTH PERIOD PRECEDING THE RESPECTIVE EVENT(S) GIVING RISE TO SUCH LIABILITY OR
OBLIGATION, AND SHALL NOT INCLUDE ANY PARTICIPATION FEES PAID TO ISO. FOR ALL PRODUCTS WHERE
LICENSEE PAYS FOR THE PRODUCT ON A TRANSACTION BASIS, ISO’S LIABILITY SHALL BE LIMITED TO THE
AMOUNT PAID FOR THE SPECIFIC TRANSACTION GIVING RISE TO SUCH LIABILITY OR OBLIGATION. THE
INFORMATION INCLUDED IN THE PRODUCT(S) MAY BE STATISTICAL SAMPLES AND/OR ACTUARIAL CALCULATIONS,
AND ISO MAKES NO WARRANTIES OR
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REPRESENTATIONS, EITHER EXPRESS OR IMPLIED, THAT THE PRODUCTS WILL ACCURATELY REFLECT, PREDICT OR
RESEMBLE EXPERIENCE FOR THE ENTIRE INSURANCE INDUSTRY OR ANY INSURER(S). ALL ISO SERVICES AND
PRODUCTS ARE ADVISORY AND ARE PROVIDED AS IS. ISO DOES NOT WARRANT THE COMPLETENESS, ACCURACY OR
CURRENCY OF THE PRODUCT OR THE INFORMATION CONTAINED THEREIN. ISO SHALL HAVE NO LIABILITY FOR
CONCLUSIONS THAT MAY BE REACHED BY THE LICENSEE.
Except as provided herein, neither ISO, its directors, officers, employees, agents, or participants
shall be liable to Licensee, nor to anyone else, for any loss or damage of any kind and however
caused, including without limitation, any special, incidental, indirect, consequential or exemplary
damages, losses or expenses, including, without limitation, lost profits, failure to realize
expected savings or any other commercial or economic loss of any kind resulting from Licensee’s use
of the Product(s). Licensee agrees to indemnify and hold ISO harmless from and against any loss,
damage, claim, suit or expense, including reasonable attorney’s fees, arising out of or relating to
the improper use of the Product(s) by Licensee. With respect to Product(s) provided to Licensee
electronically, ISO does not warrant that access will be available during all scheduled hours of
operation. ISO represents it will use best efforts to correct any ISO system malfunction causing
any unavailability in a timely manner. Oral statements do not constitute warranties, shall not be
relied upon by Licensee, and are not part of this Agreement.
12.
INDEMNIFICATION BY ISO: Licensee shall notify ISO promptly of any claim that any
Product, or Licensee’s use of any Product, is improper or illegal or violates the rights of any
third party. ISO agrees to defend, indemnify and hold Licensee harmless from and against any loss,
cost, expense, damage or liability resulting from any claim or suit brought against Licensee based
on an allegation that a Product, when properly used as permitted herein, infringes any United
States copyright, trademark, patent or other intellectual property right, provided that Licensee,
within fifteen (15) days of receipt of notice of any such alleged infringement, notifies ISO of
such allegation in writing. ISO shall have the sole right to conduct the defense of any such claim
or suit and all negotiations for its settlement or compromise, unless otherwise mutually agreed to
in writing by the parties hereto. In the event that Licensee’s use of any Product is held to
constitute an infringement and use of that Product is permanently enjoined, ISO shall, at its
option and expense, either:
a. procure for Licensee the right to continue using such Product; or
b. modify such Product to become non-infringing; or
c. replace such Product with an equally suitable, compatible and functionally equivalent
non-infringing product; or if the foregoing is unavailable
x. xxxxx Licensee a pro-rata refund of the charges paid for such Product provided that prior to
paying such refund Licensee returns such Product and all copies and partial copies thereof to ISO.
Should Licensee learn of the infringement of any Product(s) licensed under this Agreement, Licensee
shall promptly advise ISO in writing, providing ISO with any available evidence of infringement. In
any such infringement suit as ISO may determine to institute to enforce its intellectual property
rights, Licensee shall, at the request and expense of ISO, cooperate with ISO in all reasonable
respects, including having its employees with relevant information provide such information to ISO
and testify when requested by ISO and make available to ISO any relevant records, papers,
information and the like.
13.
PROPER NOTICE: Unless otherwise provided in this Agreement, all notices, directions,
instructions, orders, requests, demands, acknowledgments and other communications required or
permitted to be given hereunder shall be in writing, addressed to the parties at their respective
addresses set forth at the beginning of this Agreement or to such other addresses as one party may
furnish in writing to the other, and shall be deemed properly given or made when:
a. delivered personally;
b. made or given by prepaid telex, telegraph, facsimile or telecopy; or
c. received by first class mail, postage prepaid, or upon the expiration of three (3) days after
any such notice, direction, instruction, order, request, demand, acknowledgment or other
communication is deposited in the United States mail for transmission by first class mail, postage
prepaid, whichever shall occur first.
14.
SURVIVAL OF TERMS: The terms and conditions of Sections 4 through 7 and 9 through 16
shall survive the termination of this Agreement.
15.
CHOICE OF LAW AND EXCLUSIVE JURISDICTION AND VENUE FOR ADJUDICATING ANY DISPUTE: This
Agreement shall be governed by and construed in accordance with the laws of the State of
New York
as an agreement made and wholly performed therein. Any litigation, action, or proceeding arising
out of any dispute concerning or otherwise attempting to enforce, interpret, or remedy any breach
of this Agreement shall be brought only in a court of competent jurisdiction (whether federal or
state) sitting within the State and County of
New York. The parties irrevocably and
unconditionally (a) submit to personal jurisdiction in the State of
New York and
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consent to venue in the County of
New York with respect to any such action, (b) waive any objection
to the jurisdiction and venue in the State and County of
New York, and (c) agree not to plead or
claim in any such court that any such suit, action or proceeding has been brought in an
inconvenient forum.
16.
COUNTERPARTS. This Agreement may be executed in separate counterparts, each such
counterpart being deemed to be an original instrument, and all such counterparts shall together
constitute the same agreement.
17.
GENERAL: This Agreement, and the Annexes and Supplement(s), contains the entire
agreement of the parties, shall prevail over and supersedes all previous written and oral
agreements or terms and conditions of any purchase order, acknowledgement form, or other
instrument, or any promotional, marketing, or advertising materials (including without limitation
any memorandums of understanding and written proposals) with respect to the subject matter hereof.
This Agreement, and the Annexes and Supplements, may be changed or modified only in a writing
signed by both parties. If any provision of this Agreement is determined to be invalid under any
applicable statute or rule of law, it is, to the extent invalid, deemed to be omitted and the
remaining provisions of the Agreement shall continue in full force and effect. The failure or
delay of either party to insist upon the performance of any of the terms of this Agreement in any
one or more instances will not be construed as a waiver or relinquishment of the future performance
of any such term, and the obligation of the parties with respect to any such future performance
will continue in full force and effect. This Agreement inures to the benefit of and is binding
upon the successors and assigns of ISO and may be assigned by ISO to any of its subsidiaries,
affiliates, or related companies. It likewise inures to the benefit of Licensee, but no interest
herein shall be transferred or assigned in any manner by Licensee.
This contract is not valid against ISO unless and until executed by the appropriate ISO officer or
authorized representative at the appropriate ISO home office.
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INSURANCE SERVICES OFFICE, INC. |
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on behalf of itself, its subsidiaries and affiliates (ISO) |
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Signed:
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Signed:
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Name:
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Title:
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January 2005 Master Agreement — Property Casualty Insurers.doc
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| Line of Insurance Original or Revision Orginal Participation for This Line of insurance |
| Deletion Revised Participation (or this Line of Insurance
COMMERCIAL AUTOMOBILE code 50 orDeletlon DelellonollhlsUne0,^^
Rutes Forms
Effective Date |
| MonthDayYear I
\ Type of State Filing
\ Participation \ Services \ Authorization \
\ |cmcM|i»r«nm |
| 01 02 03 04 05 06 07 08 09
Alabama 01
Alaska 54 |
| Colorado OS ___•i — n
Connecticut 06 ‘ 7 |
| Delaware 07 S
Dist. of Col. 08 g
Xxxxxxx 00 0 »
Xxxxxxx 00 §
Idaho 11 §
Illinois 12 |
| Indiana 13 •|
Iowa 14 &
Kansas 15 7 |
| Kentucky 16 s
Louisiana 17 §
Maine 1 8 1 |
| Maryland 19 o
Michigan 21 ^
Minnesota 22 s
Mississippi 23 3 |
| Montana 25 i
Nebraska 26 1 |
| Nevada 27 mm s
New Hampshire 28 |
| North Carolina” 32
North Dakota 33 |
| _
Wyoming 49
Virgin Islands 60
Guam 61 |
| Please complete a separate form lor Texas Statistical Agent Service. XX xxx New York rules
Is applicable to classlllcation and territories only. |
Note: In certain states, services may be limited by law.
Rating Information Services correspond to loss/cost and rules services. |
| Revised Participation (or this Line of Insurance
COMMERCIAL AUTOMOBILE code 010 |
| PBRSOlSrAL AUTOMOBILE I n I | or Deletion
Revised Participation lor this Line of Insurance |
| (L T AT3TT PTTV jfco T3TTVQTnAT T» A TUT AntT\w 1 U WCKUIUH
(. L ilAPJLUJJ. I PC Jrxl I BIOJiJ-i lJ.flJVLeHj.CiJ CODEI I II O Deletion ol this Una of Insurance
r~~| I r~| I r~~| ILine Services Rules Forms
Effective Date I I I I II I i—i
i—i |
| Month Day Year I | | .................................... | |
| ~S.CONT\Typeof\ State \ Filing \ \\ <j> \ \
Participation \ Services \ Authorization \ \ \ \ \ \
MiaeM Pi,r il.lal .. \ ........................... \ \ % \ \ |
| Alaska 54 u u U
Arizona 02 :* 4
Arkansas 03 mm 8’ V
California 04 mm ^ a 1 $
mm
Colorado OS •1 mm &
Connecticut 08 « w x
Delaware 07 i 1 |
| Dist. ol Col. 08 §
Florida 09 mm d- 1 IT
Georgia 1 0 I § %
D)
Idaho 11 8 |
| Illinois 12 mm § i
Indiana 13 <? •g 5 |
| Iowa 14 a a g.
Kansas 15 sr 7 |
| Louisiana 17 0 0 S
Maine 18 I «• $
Maryland 19 5 n o
Michigan 21 o-
Minnesota 22 1 s 8 |
| Missouri 24 p %
Montana 25 §: 3;
Nebraska 28 •a f 1 |
| Nevada 27 s 3 ?
Xxx Xxxxxxxxx 00 |
| Texas 42 mm mm ••
Utah 43 |
| Wyoming 49 ___
Virgin Islands 60 mm mm ... •• ••
Guam 61 ^M •I I mm •i mm |
| Revised Participation (or this Line of Insurance
COMMERCIAL AUTOMOBILE code 060 |
| r\ & r\ nr DalAttnn Q Revised Participation (or
this Une of Insurance |
| BOILER & MACHINERY ^ |0|6|0| orPeletlon dd^o..^^..^
I I I I I I I I I &nb
sp;Line Services Rules Forms
Effective Date I I I I I I I I
; I j—1 i—i |
| TVp«of ^ State \ Filing V\\
\ Participation \ Services \ Authorization \\\
\ |oh^Xlp«xxx.xx| \ ..... \\\ |
| ___01 02 03 04 05 V 06 ] 07 ~ OB 09
Month Day Year | ............... | | ............... |
| | | | | |
Alabama 01 I I
Alaska 54 1
Arizona 02
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Olst. of Col. 08
Florida 09
Georgia 10 |
| Oregon 36 H=
Pennsylvania 37 |
| Wisconsin 48 Hi •
Wyomins 49 •
Virgin Islands 50 |
| Please complele a separate xxxx xxx Texas Statistical Agent Service. ‘XX xxx New York rules is
applicable to classification and territories only. |
Note: In certain states, services may be limited by law.
Rating information Services correspond to loss/cost and rules services. |
| Participation Supplement
Line Of Insurance Original or Revision nominalP«rttfPa*>nlorihlsUneolInsurance
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Effective Date I II I I I I I I &nbs
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| Month Day Year I | | ................................ | |
| ~S.CONT\TVp*of\State\ Filing^^\
Participation\ Services \ Authorization \\\
(xXxxxXxx.xx)\ ‘\\\\ |
| 01 02 03 04 05 OS 07 08 ................................................ 09 |
| Alabama 01
Alaska 54
Arizona 02 |
| Arkansas 03
California 04 |
| Kentucky 1 8
Louisiana 17 |
| Revised Participation (or this Line of Insurance
COMMERCIAL AUTOMOBILE code 290
ILine Services Rules Forms
Effective Date |
| Month Day Year I | | ................. | |
| ~S.CONT\ Type of\ State \ Filing \
\ Participation \ Services \ Authorization
\ la»oHu.r«UI«| .. \ \ ....... |
| 01 02 03 04 05 06 07 | OB | O9 |
Xxxxxxx 00
Xxxxxx 00 •
Arizona 02
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawaii 52
Idaho 1 1
Illinois 12
Indiana 13
Iowa 1 4
Kansas 15
Kentucky 16
Louisiana 1 7
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 26
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York’ 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsylvania 37
Puerto Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48 |
| Wyoming 49
Virgin Islands 50 |
| Note: In certain states, services may be limited by law. |
| ·FA for New York rules Is applicable to and territories only. |
| Participation Agreement Supplement |
| Line of Insurance
COMMERCIAL PACKAGE POLICY CODE 360 Original Or Revision °“Orginall
Participation lor this Line of Insurance or
Deletion Revlsed
Participation for this Line of Insurance
Deletion of this Line of Insurance |
| Effective Date Line Services Rules Forms |
| \ Participation \ State Sen/Ices \ \ Filing \ \ Authorization \ \
\ (check 1 per ) \ |
| 01 02 03 04 05 06 07 | OB | O9 |
Alabama 01 ••••
Alaska 54 •
Arizona 02
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawaii 52
Idaho 1 1
Illinois 12
Indiana 13
Iowa 1 4
Kansas 15
Kentucky 16
Louisiana 1 7
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 26
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York’ 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsylvania 37
Puerto Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48 |
| Wyoming 49
Virgin Islands 50 |
| Please complete a separate form for Texas Statistical Agent Service. |
| Note: In certain states, services may be limited by law. |
| ·FA for New York rules is applicable to classification and territories only. |
| Participation Agreement Supplement |
| Line of Insurance
COMMERCIAL PACKAGE POLICY CODE 360 Original Or Revision °“Orginall
Participation lor this Line of Insurance or
Deletion Revlsed
Participation for this Line of Insurance
Deletion of this Line of Insurance |
| Participation Supplement
Original Or Revision Original Participation
for this Line of Insurance Or Deletion
Line of Insurance Revlsed Participation lor this Une of
CRIME & FIDELITY CODE Insurance O Deletion of this Line of Insurance
0 7 0 |
| Effective Date Line Services Rules Forms |
| articipation State \ Filing \ \ \ Authorization \ \ \
Services
chtek 1 per
state
—— —— — |
| \ \
01 02 03 04 55 06 | 07 OB 09 |
| — — — — —— —— — — —
Alabama 01 This service
—
Alaska 54 1 |
| Arizona 02 i •
—
Arkansas 03 |
| —
Connecticut 08 u
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8 |
| —
Georgia 1 0
—
Idaho 1 1 4 |
| —
Kansas 1 5
—
Kentucky 16 |
| —
Louisiana 1 7
—
Maine 18 |
| —
Oregon 36 —
—
Pennsylvania 37 |
| —
Tennessee 41 I
—
Texas 42 |
| —
Wyoming 49 • ^mm
—
Virgin Islands 50 |
| —
t Please complete a separate from lor Texas Statistical Agent Service. *XX xxx New York rules Is applicable to classification and territories only. Note: In certain states, services
may be limited by law. Rating Information Services correspond to loss/cost and rules services.
Rev. 1/2007 |
| Participation Supplement
Original or Revision O Original Participation lor this Line
of Insurance Or Deletion n Revised
Line of Insurance Participation for this Une ol Insurance n Deletion of this
EMPLOmiKT-RELATED PRACTICES LIABILITY DOE Lins of Insurance
3 g 0
— —— —
Effective Date Line Services Rules Forms
— |
| \ Participation \ State \ Services Flling
(chek 1 per state) Authorization \ \ \ \
—— —— — |
| States v\\\\
01 02 03 04 05 | 06 I 07 08 09 |
| — — — — —— —— — — —
Ajabama 01 1 |
| —
Arkansas 03 •
—
California 04 |
| —
Nebraska 26 -=
—
Nevada 27 |
| —
Tennessee 41 I Mi ^
—
Texas 42 |
| Participation Supplement
—
Original or Revision D Original Participation for this Line of
Insurance Or Deletion ^ Revvisedl
Line of Insurance Participation lor this Line of Insurance O Deletion of this Line of
FARM noriF Insurance
0 8 0
— —— —
Effective Date Line Services Rules Forms
— |
| Participation State \ Services Filing \ \ \ Authorization \ \ \
\ (check 1 per stae)
—— —— — |
| States A \\\\\
— —
01 02 03 04 05 | OS I 07 08 09 Rev. 1/2005
— — — —— —— —— — —— —
Alabama 01 |
| —
Arizona 03 i •
—
Arkansas 03 |
| —
Colorado OS
—
Connecticut 08 |
| —
Idaho 1 1 4
—
Illinois 12 |
| —
Tennessee 41 - HZ
—
Texas 42 |
| —
West Virginia 47 — I i
—— — — |
| Wisconsin 48 m •
—
Wyomina 49 •
—
Virgin Islands 50 |
| —
Guam 51 I
—
Note: In certain states, services may be limited by law. Rating Information Services correspond to loss/cost and rules services. *FA for New York rules is applicable to classification and territories only. |
| Participation Supplement
—
Original or Revision Q Ori9inal
participation for this Line of Insurance Or Deletion
Line of Insurance Revised Participation for this Line of Insurance O
GENERAL LIABILITY 0 ODE Delation ol this Une ol Insurance
1 0 0
—— —
Effective Date Line Services Rules Forms
— |
| Month Day Year
—
\ Participation \
(check 1 per state) V State \ Filing \ \ \ Services Authorization \ \ \
—— — |
| Stales \
A
—
01 02 03 04 06 | 06 07 OB 09 |
| —— —— —— — —— — — — —
D 1
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1 &
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8 s 8 |
Alabama 01 I I
—— - |
| —
Arizona 02 • I
—
Arkansas 03 |
| —
Georgia 10 = =
—
Hawaii 52 |
| —
Louisiana 1 7
—
Maine 18 |
| —
Please complete a separate form for Texas Statistical Agent Service. ‘FA (or New York rules Is applicable to classification and territories only. Note: In certain states, services may be limited by law. Rating Information Services correspond to loss/cost and rules services.
Rev. 1/2007 |
| Participation Supplement }
— |
| Line of Insurance Original or Revision D °"<*ml p«rtlc|pa*” *» ins ur
» of insurance
GLASS Or Deletion ^ Revised Participation for this Line of Insurance D Deletion of this Line of Insurance
cooe GLUE
— |
| Line Services Rules Forms
Effective Date D D
-
Month Day Year
—
k Rev. |
| Participation \ foteek 1 Stalo \ Filing ‘ \ \\\
ptr *Mo) \ Services \ Authorization
—— —— — |
| \\\ \\\\\ \
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| 1 01 I 02 \ 03 [ 04 J W. } 09 07 1 08 1 08 | 11
1 10
—— —— — |
| —
Arizona 02 • I
—
Arkansas 03 |
| —
Georgia 10 = =
—
Hawaii 52 |
| —
Louisiana 1 7
—
Maine 18 |
| —
t Please complete a separate form for Texas Statistical Agent Service. Note: In certain states, services may be limited by law. |
| Participation Supplement
— |
| Participation for this Una of Insurance Or Deletion
^ Revlsed Participation for this Una of
Line of Insurance COMMERCIAL INLAUD MARINE ^ Insurance D Deletion of this Line of Insurance
1 2 0 |
| - — —
Effective Date Line Services Rules Forms
n n
—
Month Day Year
—— — |
| lypeof \ Participation State \ Services \ Filing \ V \ Aulhorlzatlon \ \ \
\ lohtcklpirilllo) ‘
—— —— — |
| States \ \ V \\v v \\ •* ‘
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01 02 03 04 05 | 06 | 07 08 09 |
| — — — — —— —— — — —
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Alabama 01 I I
—— - |
| —
Arizona 02 • I
—
Arkansas 03 |
| —
Georgia 10 = =
—
Hawaii 52 |
| —
Louisiana 1 7
—
Maine 18 |
| —
t Please complete a separate form for Texas Statistical Agent Service. ‘FA for New York rules Is applicable to classification and territories only. Note: In certain states, services may be limited by law. Rating Information Services correspond to
and rules services. R9V. 1/2005 |
| Participation Supplement
— |
| | | | | | | | | | | | | | |
Original or Revision D °"9lnal fortdpo*1” “» »i» uhb of insurance
Line of Insurance QP Deletion ^ Revised Participation for this Line of Insurance D Deletion of this Una of
MANAGEMENT PROTECTION PROGRAM ra 3DE Insurance
3 5 0 |
| - —— —
Effective Date Line Services Rules Forms
Month Day Year
—— — |
| \ Type of \ \ Participation \ State \ Services \ Filing \ \ \ Authorization \ \ \
\ lotKok 1 per itatt) ]
—— —— — |
| ^
\y\y \ A •* ‘ vw\
States \ * \ * V \ A \%« \V\\\\\\\
— —— —— —
_25___L_£2_|
01 02 03 04 05 | OB j 07 1 |
| — — — — —— —— —
Alabama 01 1 1 |
| —
™
Georgia 10 = ? I
—
Hawaii 52 |
| —
Maryland 19 =•
—
Massachusetts 20 |
| Nebraska 26 =• — = u
—
Nevada 27 |
| —
New Jersey 29 i i ^B
—— —— — |
| New Mexico 30 Et H
—
New York 31 |
| —
North Dakota 33 i i ^H
—— —— — |
| Xxxxx Xxxxxxxx 00 ^B
—— — |
| I
Wisconsin 48 El • l • Rev. 1/2005
—
Wyoming 49
—
Virgin Islands 50 |
| —
t Please complete a separate form for Texas Statistical Agent Service. Note: In certain states, services may be limited by law. |
| Participation Supplement
Line Of Insurance Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 380 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month Day Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member Subcriber Service Purchaser Loss Costs Rules forms Rules forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51 |
| Participation Supplement
Line Of Insurance Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 150 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month Day Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member Subcriber Service Purchaser Loss Costs Rules forms Rules forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51 |
| Participation Supplement
Line Of Insurance Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 370 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month Day Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member Subcriber Service Purchaser Loss Costs Rules forms Rules forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51 |
| Participation Supplement
Line Of Insurance Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 340 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month Day Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member Subcriber Service Purchaser Loss Costs Rules forms Rules forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51 |
| Participation Supplement
Line Of Insurance Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 330 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month Day Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member Subcriber Service Purchaser Loss Costs Rules forms Rules forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51 |
| Participation Supplement
Line Of Insurance Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 090 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month Day Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member Subcriber Service Purchaser Loss Costs Rules forms Rules forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51 |
| Participation Supplement
Line Of Insurance Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 020 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month Day Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member Subcriber Service Purchaser Loss Costs Rules forms Rules forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51 |
| Participation Supplement
Line Of Insurance Original Or Revision n Original Participation this Line of Insurance
MARKET SEGMEMTS coDE 030 or Deletion n Revised Participation for this line of
Insurance
Line Services Rules Forms
Effective Date
Month Day Year
Type of \ state \ Filing \ \ Perticipation \ Services
\ Authorization \ \
(check per state) \ \ \ \
Member Subcriber Service Purchaser Loss Costs Rules forms Rules forms
Statistical Agent Service
States
01 02 03 04 09 08 | 07 | 08 09
Alabama 01
Alaska 54
Arizona 02 .
Arkansas 03
California 04
Colorado 05
Connecticut 06
Delaware 07
Dist. of Col. 08
Florida 09
Georgia 10
Hawali 52
Idaho 11
Illinois 12
Indiana 13
Iowa 14
Kansas 15
Kentucky 16
Louisiana 17
Maine 18
Maryland 19
Massachusetts 20
Michigan 21
Minnesota 22
Mississippi 23
Missouri 24
Montana 25
Nebraska 28
Nevada 27
New Hampshire 28
New Jersey 29
New Mexico 30
New York 31
North Carolina 32
North Dakota 33
Ohio 34
Oklahoma 35
Oregon 36
Pennsyivania 37
Puerio Rico 58
Rhode Island 38
South Carolina 39
South Dakota 40
Tennessee 41
Texas 42
Utah 43
Vermont 44
Virginia 00
Xxxxxxxxxx 00
Xxxx Xxxxxxxx 47
Wisconsin 48
Wyoming 49
Virgin Islands 50
Guam 51 |
| Participation Agreement Supplement Line Of Insurance Original Participation for this Line of Insurance
Revised Participation for this Line of Insurance Deletion of this Line of Insurance PERSONAL INLAND MARINE
CODE 040 or Deletion Line Services Rules Forms Effective Date Month Day Year Type of Participation
check 1 per state) State Services Filing Authorization Rating Information States Member Subscriber
Service Purchaser Service Forms Rulles Forms Statistioal Agent Service Actuarial Service 01 02 03 04 05 06 07 08 09
Alaska 54 Arizona 02 This Arkansas 03 Connecticut 06 Delaware 07 Dlst. of Col. 08 Florida 09 2 Georgia 10
Hawaii 52 Kansas 15 Kentucky 16 3. Louisiana 17 Maine 18 Maryland 19 Massachusetts 20 Michigan 21 *
Minnesota 22 Missouri 24 Montana 25 Nebraska 26 Nevada 27 New Hampshire 28 New Jersey 29 New Mexico 30 New York 31
North Carolina 32 North Dakota 33 Ohio 34 Oklahoma 35 Oregon 36 Pennsylvania 37 Puerto Rico 58 Rhode Island 38
South Carolina 39 South Dakota 4D Tennessee 41 Texas 42 Utah 43 Vermont 44 Virginia 00 Xxxxxxxxxx 00 Xxxx Xxxxxxxx 47
Wisconsin 48 Wyoming 49 Virgin Islands 60 Guam 61 Note: In certain states, services may be limited by law.
Rating Information Services correspond to loss/cost and rules services. Rev. 4/2003 |
Participation Supplement Line of Insurance PERSONAL LIABILITY code 045 Original or
Revision or Deletion Original Participation for this Line of Insurance Revised Participation
for this Line of Insurance Deletion of this Line of Insurance Effective Date Month Day Year
Line Services Rules Forms State Services Filing .Authorization Participation check 1 per state)
Rating Information
States Member Subscriber Service Purchaser Service Forms Rulles Forms Statistioal
Agent Service Actuarial Service 01 02 03 04 05 O6 07 08 Alabama D1 Alaska 54 I Arizona D2 Arkansas 03
California 04 Colorado OS Connecticut 06 Delaware 07 Dlst. of Col. 08 Florida 09 Georgia 10 Hawaii 52 Idaho 11
Illinois 12 Indiana 13 Iowa 14 Kansas 15 Kentucky 16 Louisiana 17 Maine 18 Maryland 19 Massachusetts 20 Michigan 21
Minnesota 22 Mississippi 23 Missouri 24 Montana 25 Nebraska 26 Nevada 27 New Hampshire 28 New Jersey 29
New Mexico 30 New York 31 North Carolina 32 North Dakota 33 Ohio 34 Oklahoma 35 Oregon 36
Pennsylvania 37 Puerto Rico 58 Rhode Island 38 South Carolina 39 South Dakota 40 Tennessee 41 Texas 42 Utah 43
Vermont 44 Virginia 00 Xxxxxxxxxx 00 Xxxx Xxxxxxxx 47 Wisconsin 48 Wyoming 49 Vlrgin Islands 60 Guam 61
Note: In certain states, services may be limited by law. Rating Information Services correspond to loss/cost
and rules services. FA for New York rules is applicable to classification and territories only. Rev. 1/2005 |
| Participation Supplement—Instructions General Instructions Please complete a separate Participation
Agreement Supplement for each line of insurance for which you need our services.
Lines of Insurance The lines of Insurance serviced by ISO are: Personal Lines Commercial Lines
Personal Automobile Commercial Automobile (Liability and Physical Damage) · Boiler & Machinery ·
Dwelling Property Crime & Fidelity Homeowners E-commerce Personal Inland Marine Farm Personal Liability
Financial Institutions Commercial Property General Liability Glass Commercial Inland Marine Commercial Package Policy
· Professional Liability Businessowners · Employment-Related Practices Liability · Market Segments
· Commercial Umbrella · Capital Assets (Output Policy) · Management Protection Program
Note: Basic Service is automatically provided to all companies participating for any Line Service
or Actuarial Service. Effective Date The effective date should be a current or prospective date.
Please use two- digit numerical entries for month/day/year. Format On the front of the Participation
Agreement Supplement, please select: · the effective date of this participation; · the type of participation
you want; · the specific services you want. On the back of the Participation Agreement Supplement, please:
· identify your company/group; · have an authorized official of your company sign the form. .
How to Indicate Changes If this is an original submission for this line of insurance, the form
you submit to us should fully represent your entire desired participation at the date of signing.
When you wish to revise an existing participation, indicate on the Participation Agreement Supplement
only those items that are to be changed. If you are expanding your participation, place an (x) in the
appropriate box(es). Place an (o) in the appropriate box(es) to delete any participation service.
A check in the Deletion box will delete your participation for the entire line of insurance.
Type of Service Please indicate the specific services you want by indicating an (x) in the
appropriate boxes. The following guide may be helpful in identifying which services and products
are available for each participation. Line Service — Rules —This service entitles your company to
receive our multistate rules information distributed by circular and by manual. Over Rev. 1/2005 |
| Participation Supplement—instructions (cont’d) Type of Service . Line Service — Forms
—This service entitles your company to receive our multistate forms information distributed by
circular and by forms portfolio manual. • State Service — Rating Information Services This service
entitles your company to receive our advisory loss costs and rules information for the specific state(s) selected.
A company must also be participating for Line Service — Rules and State Service — Rules in order to obtain
this service. — Forms This service entitles your company to receive our forms information for the specific
state(s) selected. A company must also be participating for Line Service — Forms in order to obtain this service.
Filing Authorization This service authorizes ISO to file its Rules and/or Forms on your behalf and is available
only to those Member and Subscriber companies also participating for the corresponding State Services. In addition
to completing the appropriate columns on this Participation Agreement Supplement, please complete a Filing
Authorization Form. Central Distribution — Forms Central Distribution — Forms entitles companies to order
multiple copies of ISO’s forms and endorsements. Statistical Agent Service This service authorizes ISO to act
as your company’s statistical agent. ISO’s Statistical Division will contact you with pertinent instructions
and eligibility requirements for the various types of statistical plans, and will assist you in selecting the
most practical plan available to suit your needs. Actuarial Service For all lines of insurance, you must also
participate for Line Service — Rules in order to obtain Actuarial Service. The Actuarial Service participation
is a single countrywide participation per line, although both countrywide and state information is supplied.
Check the box at the top of the appropriate column to participate for this service.
Manuals and Circulars Please complete and return the appropriate order forms in order to receive ISO’s
manual and circular services. Please feel free to contact ISO Customer Service at 0-000-000-0000 option 2
if you require assistance in ordering any of our products. Return Address Please return your completed
Participation Agreement Supplements to: ISO Customer Service 000 Xxxxxxxxxx Xxxxxxxxx Xxxxxx Xxxx, XX 00000-0000
Questions If you have any questions about the completion of these forms, or about your company’s ISO participation,
please feel free to contact Customer Service at 0-000-000-0000, Option 2 or Fax: (000) 000-0000. Rev. 11/2004 |
INSURANCE SERVICES OFFICE, INC. Participation Supplement—Texas: Instructions General Instructions
Please complete this supplement for all companies writing business in Texas. If you have not already done
so, you must also execute the ISO Master Agreement. How to Complete This Form 1. On the first page of the
Participation Supplement Texas, please identify your company name, NAIC company number and NAIC group number,
and company IRD #. 2. For each line of insurance for which you write business in Texas, please select the
reporting option you want as indicated in the
appropriate sections. 3. On the back page of the Participation
Supplement Texas, please have an authorized official of your company sign the form, and complete
remaining
information on the back page. 4. One supplement can be used for several companies ONLY if the information is
identical for all companies listed. All companies for which participation information applies should be listed
on the back page. Separate supplement forms are needed for each company with unique statistical reporting
information. How to Indicate Changes If this is an original submission, the form you submit should fully
represent your reporting options for all commercial lines you write in Texas. If you need to make a revision
to any selection, expand into new lines of insurance, or delete a prior selection (if you no longer write that
type of insurance), place an (x) in the appropriate box(es). A check xxxx in the Delete box indicates your
company no longer writes that line of insurance. In all cases, the deletion of a line of insurance requires
an exemption from the Texas Department of Insurance (TDI). To add or delete a company from your group, please
indicate on the back page. Statistical Reporting Date This date should identify the earliest quarter/year
when data will be submitted to ISO. Return Address Please return your completed Participation Supplement Texas to:
Insurance Services Office, Inc. Customer Service Division 000 Xxxxxxxxxx Xxxxxxxxx Xxxxxx Xxxx, XX 00000-0000
Questions If you have any questions about the completion of this form, please feel free to contact our Customer
Service Division at (000) 000-0000 opt. 2. Fax: (000)000-0000. |
| INSURANCE SERVICES OFFICE, INC. |
| Participation Supplement—Texas
TEXAS COMMERCIAL LINES STATISTICAL AGENT SERVICE Service
Purchaser Participation
Name of Group/Co.: NAIC Group#: Original or Revision Original Participation
NAIC Company *: ...................... Revised Participation IRD#: |
| Insurers may report under the format of ISO’s amended Commercial Statistical Plan for
Texas (CSP Plus) or the format of the Texas Commercial Lines Statistical Plan
(TCLSP). For Liability, Property, Businessowners, Commercial Automobile and
Miscellaneous Commercial, data reported under CSP Plus may be utilized in ISO loss
cost development at each insurer’s option. If you give ISO permission to utilize the
data you report under CSP Plus in our loss cost development, the ISO statistical
reporting credit program will be applicable to the data. Data reported under TCLSP is
not utilized in ISO loss cost development and therefore is not eligible for a
statistical reporting credit. |
| Please indicate the line categories for which you will report Texas commercial
statistical data, and whether the data can be utilized in ISO loss cost development,
by checking all appropriate boxes: |
| LINES OF INSURANCE
LIABILITY
General Liability code 100 |
| Data will be reported in CSP Plus format. Data may be utilized in ISO
loss cost development (data is eligible for the ISO statistical
reporting credit program). |
| Add/New Delete Change format |
| Data will be reported in CSP Plus format. Data may not be utilized in
ISO loss cost development (data is not eligible for the ISO statistical
reporting credit program). |
| Add/New Delete Change format |
| Data will be reported in TCLSP format. Data reported in this format is
not utilized in ISO loss cost development (data is not eligible for the
ISO statistical reporting credit program). |
| Add/New Delete Change format |
| Vendor (if applicable): (e.g., TICO) |
| Medical Professional Liability code 150 |
| Data will be reported in CSP Plus format. Data may be utilized in ISO loss
cost development (data is eligible for the ISO statistical reporting credit
program). |
| Add/New Delete Change format |
| Data will be reported in CSP Plus format. Data may not be utilized in ISO
loss cost development (data is not eligible for the ISO statistical
reporting credit program). |
| Add/New Delete Change format |
| Data will be reported in TCLSP format. Data reported in this format is not
utilized in ISO loss cost development (data is not eligible for the ISO
statistical reporting credit program). |
| Add/New Delete Change format
Vendor (if applicable): (e.g., TICO)
COMMERCIAL PROPERTY code 090 |
| Data will be reported in CSP Plus format. Data may be utilized in ISO loss
cost development (data is eligible for the ISO statistical reporting credit
program). |
| Add/New Delete Change format |
| Data will be reported in CSP Plus format. Data may not be utilized in ISO
loss cost development (data is not eligible for the ISO statistical reporting
credit program). |
| Add/New Delete Change format |
| Data will be reported in TCLSP format. Data reported in this format is not
utilized in ISO loss cost development (data is not eligible for the ISO
statistical reporting credit program). |
| Add/New Delete Change format |
| Vendor (if applicable):(e:g., TICO) |
| Data will be reported in CSP Plus format. Data may be utilized in ISO loss
cost development (data is eligible for the ISO statistical reporting credit
program). |
| Add/New Delete Change format |
| Data will be reported in CSP Plus format. Data may not be utilized in ISO
loss cost development (data is not eligible for the ISO statistical
reporting credit program). |
| Add/New Delete Change format |
| Data will be reported in TCLSP format. Data reported in this format is not
utilized in ISO loss cost development (data is not eligible for the ISO
statistical reporting credit program). |
| Add/New Delete Change format
Vendor (if applicable): (e.g.,TICO)
COMMERCIAL AUTOMOBILE code 050 |
| Data will be reported in CSP Plus format. Data may be utilized in ISO loss
cost development (data is eligible for the ISO statistical reporting credit
program). |
| Add/New Delete Change format |
| Data will be reported in CSP Plus format. Data may not be utilized in ISO
loss cost development (data is not eligible for the ISO statistical reporting
credit program). |
| Add/New Delete Change format |
| Data will be reported in TCLSP format. Data reported in this format is not
utilized in ISO loss cost development (data is not eligible for the ISO
statistical reporting credit program). |
| Add/New Delete Change format |
| Vendor (if applicable):(e.g., TICO) |
| MISCELLANEOUSCOMMERCIALBoiler&Machinerycode060DatawillbereportedinCSPPlusformat.DatamaybeutilizedinI
SOlosscostdevelopment(dataiseligiblefortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangef
ormatDatawillbereportedinCSPPlusformat.DatamaynotbeutilizedinISOlosscostdevelopment(dataisnoteligibl
efortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangeformatDatawillbereportedinTCLSPforma
t.DatareportedinthisformatisnotutilizedinISOlosscostdevelopment(dataisnoteligiblefortheISOstatistica
lreportingcreditprogram).Add/NewDeleteChangeformatVendor(ifapplicable):(e.g.,TICO)BurglaryandTheftco
de070DatawillbereportedinCSPPlusformat.DatamaybeutilizedinISOlosscostdevelopment(dataiseligibleforth
eISOstatisticalreportingcreditprogram).Add/NewDeleteChangeformatDatawillbereportedinCSPPlusformat.Da
tamaynotbeutilizedinISOlosscostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcreditprogr
am).Add/NewDeleteChangeformatDatawillbereportedinTCLSPformat.Datareportedinthisformatisnotutilizedin
ISOlosscostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcreditprogram).Add/NewDeleteCha
ngeformatVendor(ifapplicable):(e.g.,TICO) |
| Glasscode110DatawillbereportedinCSPPlusformat.DatamaybeutilizedinISOlosscostdevelopment(dataiseligib
lefortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangeformatDatawillbereportedinCSPPlusfo
rmat.DatamaynotbeutilizedinISOlosscostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcred
itprogram).Add/NewDeleteChangeformatDatawillbereportedinTCLSPformat.Datareportedinthisformatisnotuti
lizedinISOlosscostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcreditprogram).Add/NewDe
leteChangeformatVendor(ifapplicable):(e.g.,TICO)CommercialInlandMarinecode120DatawillbereportedinCSP
Plusformat.DatamaybeutilizedinISOlosscostdevelopment(dataiseligiblefortheISOstatisticalreportingcred
itprogram).Add/NewDeleteChangeformatDatawillbereportedinCSPPlusformat.DatamaynotbeutilizedinISOlossc
ostdevelopment(dataisnoteligiblefortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangeforma
tDatawillbereportedinTCLSPformat.DatareportedinthisformatisnotutilizedinISOlosscostdevelopment(datai
snoteligiblefortheISOstatisticalreportingcreditprogram).Add/NewDeleteChangeformatVendor(ifapplicable
):(e.g.,TICO) |
| FIDELITY&SURETYcode310MonolinePackageDatawillbereportedinCSPPlusformat.Add/NewDeleteChangeformatData
willbereportedinTCLSPformat,Add/NewDeleteChangeformatVendor(ifapplicable):(e.g.,TICO)MISCELLANEOUSPE
RSONALcode200PersonalTheftPersonalInlandMarinePersonalGlassPersonalLiabilityDatareportedunderthemisc
ellaneouspersonalcoverageslinecategoryisforTexasCommercialLinesStatisticalAgentServicerequirementson
ly.CompaniesparticipatingforISOpersonallinesdatareportingmustcontinuetoalsoreportthisdataundertheapp
licableISOstatisticalplanandreportingrequirements.DatawillbereportedinCSPPlusformat.Add/NewDeleteCha
ngeformatDatawillbereportedinTCLSPformat.Add/NewDeleteChangeformatVendor(ifapplicable):(e.g.,TICO) |
| ParticipationSupplement-Texas(cont’d)AgreementThisparticipant,asaServicePurchaserofInsuranceServices
Office,Inc.,agreestoabidebytheprovisionsoftheParticipationSupplementexecutedbytheparticipant.Authori
zedOfficialSignatureNameTitleStatisticalReportingDate(earliestquarter/yearwhendatawillbesubmitted)Gr
oupName(ifapplicable)andNAICGroupNumberIfchanginggroups,indicateoldNAICGroup#:andthennewNAICGroup#:C
ompanyNameNAICCo.#AddDeleteCompany(ies)forwhichallparticipationinformationonthisformappliesandforwhi
chsignerisauthorizedtoactSeparateSupplementalFormsareneededforeachcompanywithuniquestatisticalreport
inginformation.CheckAddorDeleteboxifadding/deletingcompanyfromgroupentirely.HomeOfficeAddressStatist
icalContactStreetAddress/P.O.BoxCity/State/ZipTelephoneNo.TelephoneNo.FaxNo.FaxNo.E-mailE-mailDateFo
rmCompletedReturntoInsuranceServicesOffice,Inc.CustomerServiceDivision545WashingtonBoulevardJerseyCi
ty,NJ07310-1686 |
| PARTICIPATIONSUPPLEMENTDescription:Thisparticipant,asaMember,Subscriber,orServicePurchaserofInsuranc
eServicesOffice,Inc..agreestoabidebytheprovisionsoftheMasterAgreementexecutedbytheparticipant.Delive
ry:StandardISOnetInternetdelivery.Apasswordisrequired.Eachsign-onandpasswordmaybeusedonlybyoneauthor
izedindividual.ISOwillestablishaccessbasedonyourcompany’slevelofParticipation.Aregistrationkey,withu
nlimitedseats,willbeprovidedsoyoucanaccessthefollowingproductsviaISOnet:CommercialLinesManual(includ
ingMotorCarrierDigest)PersonalLinesManual(includingtheMicrosoftWorddownload)CircularsFormsFIRSTLegis
lativeMonitoringMulti-LineClassTableParticipationPlusCustomer.(ElectronicDeliveryFeeandTermDoNotAppl
y)ElectronicDeliveryFee:%(plusapplicabletaxes)Term:GroupName(ifapplicable):Company(ies)forwhichallpa
rticipationinformationonthisformappliesandforwhichsignerisauthorizedtoact:HomeOfficeAddress:StreetAd
dress/P.O.BoxCity/State/ZIPSignature:PrintName:NameofRegKeyCoordinator:Title:Title:Email:Email:Phone
Number:PhoneNumber:Date:Revised |
| PARTICIPATIONSUPPLEMENTFORCHANGESTOPARTICIPATIONDescription:Thisparticipant,asaMember.Subscriber,orS
ervicePurchaserofInsuranceServicesOffice,Inc.,agreestoabidebytheprovisionsoftheMasterAgreementexecut
edbytheparticipant.GroupName(ifapplicable):Company(ies)forwhichallparticipationinformationonthisform
appliesandforwhichsignerisauthorizedtoact:HomeOfficeAddress:StreetAddress/P.O.BoxCity/State/ZIPSigna
ture:PrintName:Title:Email:PhoneNumber:Date:Revised |
| FilingAuthorizationFormDonotsandthislettertotheNewYorkStateInsuranceDepartmentPleasesenditto:ISOCust
omerService545WashingtonBoulevardJerseyCity.NJ07310-1685TotheCommissionerofInsurance:Youareherebyaut
horizedtoacceptasfledonbehalfoftheundersignedMEMBERorSUBSCRIBERofINSURANCESERVICESOFFICE,INC..suchma
terialspecifiedonthisformrelatedtoClassifications,Rules,RatingPlansandRules,PolicyFormsandEndorsemen
tsandanyinformationpertainingthereto,whicharefiledInyourofficebyInsuranceServicesOffice,Inc.withresp
ecttooneormorekindsofinsurance,subdivisionsandkindsofInsuranceorclassesofrisks,oranypartofcombinatio
nofthaforegoingforwhichtheundersignedIsnoworhereafterlicensedlotransactbusiness.ThisRingAuthorizatio
nshallbedeemedamendedtotheextentthatanyrangIsmadeInyourofficedirectlybytheunder—signedcompanyandisin
consistentwiththefilingofsaidInsuranceServicesOffice,Inc.ThisFilingAuthorizationreplacesanyauthoriza
tioncurrentlyinyourofficeonbehalfoftheundersignedcompanyandmayberevokedoramendedatanytimebysuchactio
nasspecificallysetforthorbynotificationtoyourofficebytheunder—signedcompanyorbyInsuranceServicesOffi
ce,Inc.SignatureorOfficialTypedNameandTitleofOfficialNameatCompanyHomeOfficeStreetAddressCityStateZi
pRev.10/2004FilingAuthorizationForm—InstructionsGeneralIfyourcompanyisparticipatinginISOasaMemberor
SubscriberforoneormoreSlateServicesandyouwishtograntISOfilingauthorization,thisformmustbecompletedfo
rallapplicablejurisdictions.Pleasecomplete:theflingauthorizationcolumnsoftheParticipationAgreementSu
pplement,andthisFilingAuthorizationFormLimitationsNewYorkIfyouIntendtoauthorizeISOtomatefilingsonyou
rbehalfIntheStaleofNewYork,youmustcompletetheFilingAuthorizationFormfromtheStaleofNewYorkGeneralISOc
annotfileonyourbehalfincertainjunsdictionsforcertainlinesofinsurance.ThesejurisdictionsandlinesofIns
uranceareHackedoutonthechartInsidethisform.Foradditionallimitations,seetheParticipationAgreementSupp
lementforeachlineofInsurance.FormatOnthispagearegeneralInstructionsconcerningtheFilingAuthorizationF
orm.Onthecenterpagesare:asectionforyoutoindicatetheeffectivedateofthisform;acharttoidentifywhatlines
youauthorizeustofileonyourbehallandinwhatstales:andasectionforyoutoIndicateanyexceptionstothisauthor
ization.RevisionsOncethefilingauthorizationhasbeenestablished,youmaymakeanysubsequentchangestofiling
authorizationforalineofInsuranceandstatebysendingISOaFilingAuthorizationChangeLetter.ReturntoDONOTSE
NDTHISFORMTOANYINSURANCEDEPARTMENT!PleasesendthiscompteledFilingAuthorizationFormto:ISOCustomerServi
ce545WashingtonBoulevardJerseyCity,NewJersey07310-1686ISOwillmaintaintheoriginalFilingAuthorizationF
orminitsfiles.Aphotocopyoftheformwillbesenttotheappropriateinsurancedepartment(
s).Over |
| FilingAuthorizationFormEffectiveDalePleaseIndicatethedatayouwishthisfilingAuthorizationtobeeffective
Thisdateshouldbecurrentorprospective.AuthorizationCodesInsertthecodesfistedbelowIntheappropriateboxo
fthechart,i.e.,byState,andTypesorKindsofInsurance:2.Rules6.Rules,Forms4.FormsExceptions.Exceptionsfo
rRingAuthorizationshouldbeIndicatedInthespaceprovidedbelow.Indicatetheline,thanthestate.Ifappropriat
e,followedbyadescriptionoftheexception(e.g..“ProfessionalLiability—allstates—wewillliteourownlawye
r’sprofessionalliabilityrulesandforms”).EffectiveDateForISOUseOnlyAlabamaAlaskaDelawareDist.ofColumb
iaHawaiidoholowakansaskentuckylousianaMaineMarylandpenesliviamississippijgSl^.1,.i£aNorthCorolinaohi
ooregonPenesyeviautahVermontVirginiaWashingtonWestvirginiawisconsinThesenotesapplyunlesslimitedbyane
xceptiontoStagauthority:HomeownorsincludesMobHehome:FarmInsuranceIncludesFarmCombinationCoverage.For
mProperly,Farmliability,andFarmIntendMarina:andCommercialMultipleLineincludestheCommercialPackagePol
icyProgramandtheBusinessownersProgram. |
