CODE LIST. *Effective January 1, 2013 a new company type has been added NC for Certified Reinsurer.

Transcription

1 CODE LIST Number Line of Business 1 Fire, extended coverage and other allied lines 2 Homeowners multiple peril 3 Commercial multiple peril 4 Earthquake 5 Growing crops 6 Ocean marine 7 Inland marine 8 Accident & health 9 Workers compensation 10 Liability other than auto (Bodily Injury and Property Damage) 11 Auto liability (Bodily Injury and Property Damage) 12 Auto physical damage 13 Aircraft (all perils) 14 Fidelity & surety 15 Glass 16 Burglary & theft 17 Boiler & machinery 18 Credit 19 Reinsurance 20 Life non-participating 21 Life participating 22 Variable life non-participating 23 Variable life participating 24 Variable annuities 25 Title 26 Fraternal Benefit Society 27 Mortgage guaranty 28 Health Care Center 29 See Addendum 30 See Addendum A B C D E F G HA HB I J M NA NC* ND NP NT Type of Company Property Casualty Life and Accident & Health Fraternal Benefit Society Mortgage Guaranty Title Savings Bank Departments Health Care Centers Reinsurance (property-casualty) Reinsurance (life-health) Limited Health Service Organization Pools and Associations Excess and Surplus Lines State Funds Accredited/Approved Reinsurer Certified Reinsurer Approved Reinsurer Domicile with Similar Statutes Approved Reinsurer Pool Approved Reinsurer Trust *Effective January 1, 2013 a new company type has been added NC for Certified Reinsurer.

2 Licensed Insurance Companies, Approved Reinsurers and Surplus Lines Insurers in Connecticut as of 06/30/2015 Group NAIC st Century Assurance Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE DE A st Century Casualty Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE CA A st Century Centennial Insurance Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE PA A st Century Insurance Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE CA A st Century Insurance Company of the Southwest 21st Century Plaza 3 Beaver Valley Road Wilmington, DE TX A st Century National Insurance Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE NY A st Century North America Insurance Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE NY A st Century Pacific Insurance Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE CO A st Century Preferred Insurance Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE PA A st Century Premier Insurance Company 21st Century Plaza 3 Beaver Valley Road Wilmington, DE PA A Ever Life Insurance Company 2 Mid America Plaza, Suite 200 Oakbrook Terrace, IL IL B Star Life Insurance Company 909 N. Washington Street Alexandria, VA LA B /01/2015 Page 1 of 115

3 AAA Life Insurance Company N. Laurel Park Drive Livonia, MI MI B ACA Financial Guaranty Corporation 600 Fifth Avenue, 2nd Floor New York, NY MD A 14(Financial Guaranty Only) Acadia Insurance Company P O Box 9010 Westbrook, ME NH A Accendo Insurance Company 2211 Sanders Road Northbrook, IL UT B Acceptance Casualty Insurance Company 702 Oberlin Road P O Box Raleigh, NC NE A Acceptance Indemnity Insurance Company P.O. Box Oberlin Road Raleigh, NC NE Accident Fund General Insurance Company P.O. Box Lansing, MI MI A Accident Fund Insurance Company of America P O Box Lansing, MI MI A Accident Fund National Insurance Company P.O. Box Lansing, MI MI A Accordia Life and Annuity Company th Street Suite 1100 Des Moines, IA IA B Accredited Surety and Casualty Company, Inc. P.O. Box Orlando, FL FL A ACE American Insurance Company P.O. Box Walnut Street Philadelphia, PA PA A ACE Capital Title Reinsurance Company 436 Walnut Street Philadelphia, PA NY NA 07/01/2015 Page 2 of 115

4 0 0 ACE European Group Limited Locke Lord LLP Attn: John P. Dearie, Jr. 750 Lexington Avenue New York, NY ACE Fire Underwriters Insurance Company P.O. Box Walnut Street Philadelphia, PA PA A ACE Life Insurance Company 1133 Avenue of the Americas New York, NY CT B ACE Property & Casualty Insurance Company P.O. Box Walnut Street Philadelphia, PA PA A ACIG Insurance Company 2600 N. Central Expressway Suite 800 Richardson, TX IL A Acstar Insurance Company 30 South Road Farmington, CT IL A ADM Insurance Company 76 St. Paul Street Suite 500 Burlington, VT AZ HA Admiral Indemnity Company 301 Route 17 North Suite 900 Rutherford, NJ DE A Admiral Insurance Company 7233 East Butherus Drive Scottsdale, AZ DE Advantage Workers Compensation Insurance Company P.O. Box Salt Lake City, UT IN A Aegis Security Insurance Company P O Box 3153 Harrisburg, PA PA A Aetna Better Health Inc. 980 Jolly Road, U11S Blue Bell, PA CT G 28 07/01/2015 Page 3 of 115

5 Aetna Health and Life Insurance Company 151 Farmington Avenue, RT21 Hartford, CT CT B Aetna Health Inc 980 Jolly Road, U11S Blue Bell, PA CT G Aetna Insurance Company of Connecticut 151 Farmington Avenue, RT21 Hartford, CT CT A Aetna Life Insurance Company 151 Farmington Avenue, RT21 Hartford, CT CT B Affiliated FM Insurance Company 270 Central Avenue P.O. Box 7500 Johnston, RI RI A Affirmative Insurance Company P O Box 9030 Addison, TX IL A AGCS Marine Insurance Company 225 West Washington Street Suite 2000 Chicago, IL IL A Agent Alliance Insurance Company P.O. Box 3199 Winston-Salem, NC AL Agri General Insurance Company 9200 Northpark Drive Suite 350 Johnston, IA IA A AIG Assurance Company 175 Water Street, 18th Floor New York, NY PA A AIG Property Casualty Company 175 Water Street, 18th Floor New York, NY PA A AIG Specialty Insurance Company 175 Water Street, 18th Floor New York, NY IL Aioi Nissay Dowa Insurance Company of America 475 N. Martingale Road Suite 330 Schaumburg, IL NY A /01/2015 Page 4 of 115

6 AIU Insurance Company 175 Water Street, 24th Floor New York, NY NY A AIX Specialty Insurance Company 5 Waterside Crossing Suite 201 Windsor, CT DE Alamance Insurance Company 238 International Road Burlington, NC IL A Alea North America Insurance Company CityPlace II 185 Asylum Street, 9th Floor Hartford, CT NY A All America Insurance Company P.O. Box 351 Van Wert, OH OH A All Savers Insurance Company 7440 Woodland Drive Indianapolis, IN IN B Allegheny Casualty Company One Newark Center 20th Floor Newark, NJ PA A Allianz Global Risks US Insurance Company 225 W. Washington Street Suite 2000 Chicago, IL IL A Allianz Life Insurance Company of New York One Chase Manhattan Plaza, 38th Floor New York, NY NY B Allianz Life Insurance Company of North America 5701 Golden Hills Drive Minneapolis, MN MN B Allianz Underwriters Insurance Company 225 W. Washington Street Suite 2000 Chicago, IL IL Allied Eastern Indemnity Company PO Box Lancaster, PA PA A Allied Insurance Company of America One West Nationwide Blvd, Columbus, OH OH A /01/2015 Page 5 of 115

7 Allied Property and Casualty Insurance Company One West Nationwide Boulevard Columbus, OH IA A Allied World Assurance Company (U.S.) Inc. 199 Water Street 29th Floor New York, NY DE Allied World Insurance Company 199 Water Street New York, NY NH A Allied World National Assurance Company 199 Water Street New York, NY NH A Allied World Specialty Insurance Company 1690 New Britain Avenue Suite 101 Farmington, CT DE A Allied World Surplus Lines Insurance Company 1690 New Britain Avenue Suite 101 Farmington, CT AR Allmerica Financial Benefit Insurance Company 440 Lincoln Street Worcester, MA MI A Allstate Assurance Company 3075 Sanders Road Suite H1A Northbrook, IL IL B Allstate Fire and Casualty Insurance Company 3075 Sanders Road Suite H1A Northbrook, IL IL A Allstate Indemnity Company 3075 Sanders Road Suite H1A Northbrook, IL IL A Allstate Insurance Company 3075 Sanders Road Suite H1A Northbrook, IL IL A Allstate Life Insurance Company 3075 Sanders Road Suite H1A Northbrook, IL IL B Allstate Northbrook Indemnity Company 3075 Sanders Road Suite H1A Northbrook, IL IL A /01/2015 Page 6 of 115

8 Allstate Property and Casualty Insurance Company 3075 Sanders Road Suite H1A Northbrook, IL IL A Ally International Insurance Company Ltd. 300 Galleria Officentre Floor 2 Southfield, MI Alterra America Insurance Company Ten Parkway North Deerfield, IL DE A Alterra Excess & Surplus Insurance Company 4521 Highwoods Parkway Glen Allen, VA DE Alterra Reinsurance USA Inc. 535 Springfield Avenue Summit, NJ DE HA Amalgamated Life Insurance Company 333 Westchester Avenue White Plains, NY NY B AMBAC Assurance Corporation One State Street Plaza 15th Floor New York, NY WI A 14(Financial Guaranty Only) AMCO Insurance Company One West Nationwide Boulevard Columbus, OH IA A American Accident Reinsurance Group 1 AUL Reinsurance Management Services, LLC 5 Terri Lane Burlington, NJ NP American Agri-Business Insurance Company nd Street Lubbock, TX TX A American Agricultural Insurance Company 1501 E. Woodfield Road Suite 300W Schaumburg, IL IN NA American Alternative Insurance Corporation 555 College Road East P O Box 5241 Princeton, NJ DE A American Automobile Insurance Company 777 San Marin Drive Novato, CA MO A /01/2015 Page 7 of 115

9 American Bankers Insurance Company of Florida Quail Roost Drive Miami, FL FL A American Bankers Life Assurance Company of Florida Quail Roost Drive Miami, FL FL B American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue Chicago, IL PA A American Commerce Insurance Company 211 Main Street Webster, MA OH A Travel Insurance Only American Compensation Insurance Company 8500 Normandale Lake Boulevard Suite 1400 Bloomington, MN MN A American Contractors Indemnity Company 601 South Figueroa Street 16th Floor Los Angeles, CA CA A American Country Insurance Company 150 Northwest Point Blvd Suite 300 Elk Grove Village, IL IL A American Disability Reinsurance Underwriters Syndicate Custom Disability Solutions 50 Stanford Drive, 2nd Floor Farmington, CT NP American Economy Insurance Company 175 Berkeley Street Boston, MA IN A American Empire Insurance Company P O Box 5370 Cincinnati, OH OH A American Empire Surplus Lines Insurance Company P O Box 5370 Cincinnati, OH DE American Equity Insurance Company One Tower Square Hartford, CT AZ 07/01/2015 Page 8 of 115

10 American Equity Investment Life Insurance Company P.O. Box Des Moines, IA IA B American Equity Specialty Insurance Company One Tower Square Hartford, CT CT A American Excess Insurance Association One Tower Square 2PB Hartford, CT CT J American Family Home Insurance Company P O Box 5323 Cincinnati, OH FL A American Family Life Assurance Company of Columbus 1932 Wynnton Road Columbus, GA NE B American Family Life Assurance Company of New York P O Box Albany, NY NY B American Family Life Insurance Company 6000 American Parkway Madison, WI WI B American Fidelity Assurance Company P O Box Oklahoma City, O O B American Fidelity Life Insurance Company 4060 Barrancas Avenue Pensacola, FL FL B American Financial Security Life Insurance Company Metcalf Avenue Pmb # 275 Overland Park, S MO B American Fire and Casualty Company 175 Berkeley Street Boston, MA NH A American General Life Insurance Company P O Box 1591 Houston, TX TX B /01/2015 Page 9 of 115

11 American Guarantee and Liability Insurance Company 1400 American Lane Tower 1, 19th Floor Schaumburg, IL NY A American Guaranty Title Insurance Company 4040 North Tulsa Oklahoma City, O O E American Hallmark Insurance Company of Texas 777 Main Street Suite 1000 Forth Worth, TX TX A American Health and Life Insurance Company P O Box 2548 Fort Worth, TX TX B American Healthcare Indemnity Company 1888 Century Park East Suite 800 Los Angeles, CA DE A American Heritage Life Insurance Company 1776 American Heritage Life Drive Jacksonville, FL FL B American Home Assurance Company 175 Water Street, 18th Floor New York, NY NY A American Income Life Insurance Company P O Box 2608 Waco, TX IN B American Insurance Company 777 San Marin Drive Novato, CA OH A American Long Term Care Reinsurance Group 5700 Broadmoor Suite 1000 Mission, S NP American Maturity Life Insurance Company 200 Hopmeadow Street Simsbury, CT CT B American Medical and Life Insurance Company 14 Wall Street Suite 5H New York, NY NY B American Memorial Life Insurance Company P O Box 2730 Rapid City, SD SD B 20 07/01/2015 Page 10 of 115

12 American Mercury Insurance Company P.O. Box Oklahoma City, O O A American Mining Insurance Company P.O. Box Birmingham, AL IA A American Modern Home Insurance Company P O Box 5323 Cincinnati, OH OH A American Modern Life Insurance Company 400 Robert Street North St. Paul, MN OH B American Modern Property and Casualty Insurance Company P.O. Box 5323 Cincinnati, OH OH A American Modern Select Insurance Company P.O. Box 5323 Cincinnati, OH OH A American National General Insurance Company 1949 East Sunshine American National Corporate Centre Springfield, MO MO A American National Insurance Company One Moody Plaza Galveston, TX TX B American National Life Insurance Company of Texas One Moody Plaza Galveston, TX TX B American National Lloyds Insurance Company American National Corporate Centre 1949 East Sunshine Springfield, MO TX American Network Insurance Company 3440 Lehigh Street Allentown, PA PA B American Nuclear Insurers 95 Glastonbury Boulevard Glastonbury, CT CT J 29 07/01/2015 Page 11 of 115

13 American Pet Insurance Company 907 NW Ballard Way Seattle, WA NY A American Phoenix Life and Reassurance Company P.O. Box 5056 Hartford, CT CT B American Progressive Life & Health Insurance Company of New York 44 South Broadway Suite 1200 White Plains, NY NY B American Public Life Insurance Company P.O. Box 925 Jackson, MS O B American Reliable Insurance Company 8655 E. Via De Ventura, Ste. E200 Scottsdale, AZ AZ A American Republic Insurance Company P O Box 1 Des Moines, IA IA B American Road Insurance Company (The) 1 American Road, MD 7600 Dearborn, MI MI A American Security Insurance Company 260 Interstate North Circle, SE Atlanta, GA DE A American Sentinel Insurance Company P.O. Box Harrisburg, PA PA A American Southern Home Insurance Company P.O. Box 5323 Cincinnati, OH FL A American States Insurance Company 175 Berkeley Street Boston, MA IN A American Strategic Insurance Corp. 1 ASI Way St. Petersburg, FL FL A American Summit Insurance Company P.O. Box 2650 Waco, TX TX A /01/2015 Page 12 of 115

14 American Surety Company 250 East 96th Street Suite 202 Indianapolis, IN IN A American United Life Insurance Company P O Box 368 Indianapolis, IN IN B American Western Home Insurance Company P O Box 5323 Cincinnati, OH O American Zurich Insurance Company 1400 American Lane Tower 1, 19th Floor Schaumburg, IL IL A American-Amicable Life Insurance Company of Texas P O Box 2549 Waco, TX TX B AmeriChoice of Connecticut, Inc. 185 Asylum Street Hartford, CT CT G Americo Financial Life and Annuity Insurance Company P O Box ansas City, MO TX B Amerisure Insurance Company P O Box 2060 Farmington Hills, MI MI A Amerisure Mutual Insurance Company P O Box 2060 Farmington Hills, MI MI A Ameritas Life Insurance Corp. P O Box Lincoln, NE NE B Amex Assurance Company P.O. Box Phoenix, AZ IL A AmGUARD Insurance Company P O Box A-H Wilkes-Barre, PA PA A /01/2015 Page 13 of 115

15 Amica Life Insurance Company P O Box 6008 Providence, RI RI B Amica Mutual Insurance Company P O Box 6008 Providence, RI RI A AmTrust Insurance Company of ansas, Inc. P.O. Box Dallas, TX S A AmTrust International Underwriters Limited Edward Angell Palmer & Dodge 750 Lexington Avenue New York, NY Annuity Investors Life Insurance Company P O Box 5423 Cincinnati, OH OH B Ansur America Insurance Company One Mutual Avenue Frankenmuth, MI MI A Anthem Health Plans, Inc 108 Leigus Road Wallingford, CT CT B Anthem Insurance Companies, Inc. 120 Monument Circle Indianapolis, IN IN A Anthem Life Insurance Company 2 Gannett Drive South Portland, ME IN B Appalachian Insurance Company P.O. Box 7500 Johnston, RI RI Arbella Indemnity Insurance Company 1100 Crown Colony Drive Quincy, MA MA A Arbella Protection Insurance Company Inc Crown Colony Drive Quincy, MA MA A Arch Excess & Surplus Insurance Company 300 Plaza 3 Jersey City, NJ MO 07/01/2015 Page 14 of 115

16 Arch Insurance Company 300 Plaza 3 Jersey City, NJ MO A Arch Insurance Company (Europe) Limited Locke Lord LLP Attn: John P. Dearie, Jr. 750 Lexington Avenue New York, NY Arch Mortgage Guaranty Company 3003 Oak Road Walnut Creek, CA WI D Arch Mortgage Insurance Company 3003 Oak Road Walnut Creek, CA WI D Arch Reinsurance Company P.O. Box 1988 Morristown, NJ DE A null Arch Reinsurance Ltd. (Bermuda) 1114 Avenue of the Americas 40th Floor New York, NY NC Arch Specialty Insurance Company 300 Plaza 3 Jersey City, NJ MO Argonaut Great Central Insurance Company P.O.Box San Antonio, TX IL A Argonaut Insurance Company P.O. Box San Antonio, TX IL A Argonaut-Midwest Insurance Company P.O. Box San Antonio, TX IL A Armed Forces Insurance Exchange 550 Eishenhower Rd Leavenworth, S S A Arrowood Indemnity Company 3600 Arco Corporate Drive P O Box 1000 Charlotte, NC DE A Arrowood Surplus Lines Insurance Company 3600 Arco Corporate Drive P O Box 1000 Charlotte, NC DE A /01/2015 Page 15 of 115

17 Ashmere Insurance Company 628 Hebron Avenue Suite 106 Glastonbury, CT IL A Aspen American Insurance Company 175 Capital Blvd Suite 300 Rocky Hill, CT TX A Aspen Bermuda Limited (U.S. Reinsurance Trust) C/O Drinker Biddle & Reath, LLP 1177 Avenue of the Americas 41st Floor New York, NY NJ NT Aspen Insurance U Limited (U.S. Reinsurance Trust) c/o Drinker Biddle & Reath LLP Attn: Thomas Dawson 1177 Avenue of the Americas New York, NY NY Aspen Insurance U Limited (U.S. Reinsurance Trust) c/o Drinker Biddle & Reath LLP Attn: Thomas Dawson 1177 Avenue of the Americas New York, NY NY NT Aspen Specialty Insurance Company 175 Capital Boulevard Suite 300 Rocky Hill, CT ND 0 0 Associated Accident and Health Reinsurance Underwriters International Solutions, LLC th St. North, Suite 203 St. Petersburg, FL NP 0 0 Associated Electric & Gas Insurance Services, Limited Drinker Biddle & Reath LLP Attn: Thomas Dawson 1177 Avenue of the Americas New York, NY Associated Employers Insurance Company P.O. Box 4070 Burlington, MA MA A Associated Indemnity Corporation 777 San Marin Drive Novato, CA CA A Associated Industries Insurance Company, Inc. P.O. Box Boca Raton, FL FL 07/01/2015 Page 16 of 115

18 Associated Industries of Massachusetts Mutual Insurance Company P.O. Box 4070 Burlington, MA MA A Associated Inland Marine 500 Edgewater Drive Suite 580 Wakefield, MA NP Associated International Insurance Company Ten Parkway North Deerfield, IL IL Associated International Insurance Company Ten Parkway North Deerfield, IL IL NA Assurance Company of America 1400 American Lane Tower 1, 19th Floor Schaumburg, IL NY A Assured Guaranty Corp. 31 West 52nd Street New York, NY MD A 14(Financial Guaranty Only) Assured Guaranty Municipal Corp. 31 West 52nd Street New York, NY NY A 14(Financial Guaranty Only) Assurity Life Insurance Company P.O. Box Lincoln, NE NE B Atain Insurance Company Northwestern Hwy Suite 220 Farmington Hills, MI TX A Atain Specialty Insurance Company Northwestern Highway Suite 220 Farmington Hills, MI MI Athene Annuity & Life Assurance Company P O Box Brookfield Parkway Greenville, SC DE B Athene Annuity & Life Assurance Company of New York 69 Lydecker Street Nyack, NY NY B /01/2015 Page 17 of 115

19 Athene Annuity and Life Company 7700 Mills Civic Parkway West Des Moines, IA IA B Athene Life Insurance Company of New York 7700 Mills Civic Parkway West Des Moines, IA NY B Atlantic Casualty Insurance Company P O Box 8010 Goldsboro, NC NC Atlantic Specialty Insurance Company 150 Royall Street Canton, MA NY A Atlantic States Insurance Company 1195 River Road Marietta, PA PA A Atradius Trade Credit Insurance, Inc. 230 Schilling Circle Suite 240 Hunt Valley, MD MD A ATX Premier Insurance Company 2859 Paces Ferry Road Suite 800 Atlanta, GA TX A Aurigen Reinsurance Company of America Two Bridge Avenue Suite 111 Red Bank, NJ AR HB Auto-Owners Insurance Company P O Box Lansing, MI MI NA Automobile Insurance Company of Hartford, Connecticut One Tower Square Hartford, CT CT A AutoOne Insurance Company 155 Mineola Boulevard Mineola, NY NY A Avemco Insurance Company 411 Aviation Way Frederick, MD MD A (Accidental Death and Dismemberment Only) AXA Art Insurance Corporation 3 West 35th Street New York, NY NY A 07 07/01/2015 Page 18 of 115

20 AXA Corporate Solutions Life Reinsurance Company 525 Washington Boulevard 32nd Floor Jersey City, NJ DE B AXA Equitable Life and Annuity Company 1290 Avenue of the Americas New York, NY CO B AXA Equitable Life Insurance Company 1290 Avenue of the Americas New York, NY NY B AXA Insurance Company 125 Broad Street New York, NY NY A AXIS Insurance Company Great Oaks Way Suite 500 Alpharetta, GA IL A AXIS Reinsurance Company Great Oaks Way Suite 500 Alpharetta, GA NY A AXIS Specialty Europe SE AXIS US Insurance Great Oaks Way Suite 500 Alpharetta, GA AXIS Specialty Insurance Company Great Oaks Way Suite 500 Alpharetta, GA CT A AXIS Specialty Limited (U.S. Reinsurance Trust) C/O Drinker Biddle & Reath, LLP 1177 Avenue of the Americas 41st Floor New York, NY NJ NT AXIS Surplus Insurance Company Great Oaks Way Suite 500 Alpharetta, GA IL Balboa Insurance Company 5 Park Plaza, Suite 500 Mail Stop# CA Irvine, CA CA A Baltimore Life Insurance Company Red Run Boulevard Owings Mills, MD MD B /01/2015 Page 19 of 115

21 Bankers Insurance Company P O Box St. Petersburg, FL FL A Bankers Life and Casualty Company 600 West Chicago Avenue Chicago, IL IL B Bankers Specialty Insurance Company P.O. Box St. Petersburg, FL LA Bankers Standard Insurance Company P.O. Box Walnut Street Philadelphia, PA PA A Banner Life Insurance Company 3275 Bennett Creek Avenue Frederick, MD MD B Bar Plan Surety and Fidelity Company 1717 Hidden Creek Court St. Louis, MO MO A Bay State Insurance Company 95 Old River Road Andover, MA MA A BCS Insurance Company 2 Mid America Plaza, Suite 200 Oakbrook Terrace, IL OH A Beazley Insurance Company, Inc. 30 Batterson Park Road Farmington, CT CT A Bedivere Insurance Company 1880 JF Blvd., Suite 801 Philadelphia, PA PA A Benchmark Insurance Company 100 Lake Street W Wayzata, MN S A Beneficial Life Insurance Company P.O. Box Salt Lake City, UT UT B Berkley Assurance Company 7233 E Butherus Dr Scottsdale, AZ IA 07/01/2015 Page 20 of 115