ࡱ>  [bjbj 9jjA lJJJJJJJRRR8R4RlrVrV"VVVsWsWsW$P pl?JsWoWsWsWsW?_JJVVT___sW.JVJV_sW__dJJdVfV *aORWXddj0d܄W܄d_^X@JJJJ LINE OF BUSINESS:FidelityLINE(S) OF INSURANCECODESNoneNoneCode: 23.0000IF CHECKLIST IS NOT APPLICABLE, PLEASE EXPLAIN: REVIEW REQUIREMENTSREFERENCEDESCRIPTION OF REVIEW STANDARDS REQUIREMENTSLOCATION OF STANDARD IN FILINGGENERAL REQUIREMENTS FOR ALL FILINGSCOPIES, RETURN ENVELOPES, ETCCOVER LETTEREFFECTIVE DATE WORDINGFILING SUBMISSIONFREE CONTRACT PROHIBITEDLIMITATIONS/RESTRICTIONS ON TRANSACTING BUSINESS NO FILE OR FILING EXEMPTIONSоٷ #LINE OF AUTHORITYTHIRD PARTY FILERS AUTHORITYTRANSACTING OTHER BUSINESS FORMS: POLICY PROVISIONSFORMS POLICY PROVISIONSACCESS TO COURTSAMBIGUOUS & MISLEADINGAPPLICATIONSAPPRAISALSARBITRATIONBLANK ENDORSEMENTSCERTIFICATIONSCONSUMER INFORMATIONCREDIT SCORING NOTICEPrivacy noticeVSI WarningNotification FormCONTENT OF POLICIESCOUNTERSIGNATURESDECLARATIONS PAGEDISCLOSURESDEFINITIONSDISCRIMINATIONFORMS: POLICY PROVISIONSEXCLUSIONS & LIMITATIONSTerrorismFICTITIOUS GROUPSFORMS MISCELLANEOUSFRAUD WARNINGLIMITSLOSS PAYEELOSS SETTLEMENTSAppraisalAction Against CompanyArbitrationDeductiblesDefense CostsLoss ValuationNotice RequirementsPayment of Loss Time PeriodAppraisalPOLICY MUST CONTAIN ENTIRE CONTRACTPREMIUM AUDITPUNITIVE DAMAGESREADABILITYREBATESFORMS: POLICY PROVISIONSSUBROGATIONSuitVOIDANCEWARRANTIESOTHERRATE, RULE, RATING PLAN, CLASSIFICATION, AND TERRITORY FILING REQUIREMENTSSINDIVIDUAL RISK RATINGACTUARIAL CERTIFICATIONS FOR RATESADOPTIONS OF RATE SERVICE ORGANIZATIONS (RSO) FILINGSLoss CostsCONSENT-TO-RATECREDIT SCORING AND REPORTSCREDIBILITY AND OTHER FACTORSDISCOUNTSEXPIRATION DATE(S) FOR APPROVED RATESFORMS: POLICY PROVISIONSGROUP POLICIESExtra-Territorial Approval AuthorityLOSS RATIO STANDARDSMID TERM CHANGESLOSS COST MULTIPLIERSPREMIUM REFUND OR RETENTIONPRICINGMinimum Premium RulesMulti-tierPayment Plans PremiumsService ChargesSurchargesOther FeesRATE RANGESRATING PLAN REQUIREMENTSExpense Modification PlanExperience RatingLarge DeductibleRetrospective RatingSchedule RatingSmall DeductibleWrap-up Rating RATE/LOSS COST SUPPORTING INFORMATIONCompetitionFORMS: POLICY PROVISIONSExpensesExperienceJudgmentProfit LoadingRETURN ON EQUITY DOCUMENT/INVESTMENT INCOMERISK CLASSIFICATIONTRENDING OTHER PAGE  PAGE 6 789:DEFGIJQY\]ab,<@AEcgimz~ =5CJ\^JCJ^JCJ5>*B*hphB*CJhph>*B*hph >*CJ^J5B*hph B*hph 5>*CJ\B*CJhphC1789:?Dv4n$$If4\h.N9 l94 a $$Ifa$$If $$Ifa$ AZDEFGHI~ $$Ifa$ $$Ifa$n$$If4\h.N9 l94 aIJPQYZ[H~ $$Ifa$ $$Ifa$n$$If4\h.N9 l94 a[\]^_` $$Ifa$n$$If4 \h.N9 l94 a`abcde $$Ifa$n$$If4\h.N9 l94 aefx $$Ifa$ $$Ifa$$Ifn$$If4\h.N9 l94 a~ $$Ifa$ $$Ifa$o$$IfFh.N9 l9    4 a|||| $$Ifa$ $$Ifa$p$$If4Fh.N9 l9    4 a usjjdjW $1$If]1a$$If $$Ifa$$$If4\h.N9 (l94 a,<=>?tne\\\ $$Ifa$ $$Ifa$$If$$If44N\h.N9  (l94 a?@ABCDuofff $$Ifa$$If$$If4\h.N9  (l94 aDEcdefgijklmuofffuofffuD $$Ifa$$If$$If4\h.N9  (l94 a mz{|}~[$$If\h.N9  (l94 a $$Ifa$ $$If^a$$If ulofffuofffuX $$Ifa$$If$$If4\h.N9  (l94 a fft$$If4\h.N9  (l94 a $$Ifa$$If lflf$If$$If4\h.N9  (l94 a $$Ifa$ lf$If$$If4\h.N9  (l94 a $$Ifa$ =>?@uooff $$Ifa$$If$$If4\h.N9  (l94 a=>ABFMQRVhlnr )-/3@DFJUY[_koqu"6:<@RVX\nrtx5CJ\^JaJ5\B*CJ^Jhph5CJ\^J B*hph5B*CJhphQ@ABCDEwqhhh $$Ifa$$If$$If\h.N9  (l94 aEFMNOPQRSTUVu,offfuofffuX $$Ifa$$If$$If4\h.N9  (l94 a Vhijklnopqrff$$If4\h.N9  (l94 a $$Ifa$$If lflf$If$$If4\h.N9  (l94 a $$Ifa$ ltc]$If $$Ifa$$$If4\h.N9  (l94 a $$Ifa$uofff $$Ifa$$If$$If4\h.N9  (l94 a   upofffuTofff $$Ifa$$If$$If4\h.N9  (l94 a  )*+,uofffulofff $$Ifa$$If$$If4\h.N9  (l94 a ,-/0123@ABCDuofffuDofffu $$Ifa$$If$$If4\h.N9  (l94 a DFGHIJUVWXY[f<f$$If4\h.N9  (l94 a $$Ifa$$If [\]^_klmnoqrl@flf$If$$If4\h.N9  (l94 a $$Ifa$ rstul\flf$If$$If4\h.N9  (l94 a $$Ifa$ lLflf$If$$If4\h.N9  (l94 a $$Ifa$ udofffuofff $$Ifa$$If$$If4\h.N9  (l94 a uhofffuLofff $$Ifa$$If$$If4\h.N9  (l94 a u@offf $$Ifa$$If$$If4\h.N9  (l94 auXofff $$Ifa$$If$$If4\h.N9  (l94 a !"6789:uofffu`offfu $$Ifa$$If$$If4\h.N9  (l94 a :<=>?@RSTUfX$$If4\h.N9  (l94 a $$Ifa$$If UVXYZ[uofff $$Ifa$$If$$If4\h.N9  (l94 a[\nopquXofff $$Ifa$$If$$If4\h.N9  (l94 aqrtuvwxuofffu@offfu $$Ifa$$If$$If4\h.N9  (l94 a     ! # ' ; ? 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