PENNSYLVANIA SURCHARGE DISCLOSURE STATEMENT

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1 PENNSYLVANIA SURCHARGE DISCLOSURE STATEMENT AU PA0d 0 GENERAL GENERAL GE In accordance with Pennsylvania Law, we are providing you with an explanation of our Safe Driver Insurance Plan, under which your policy has been rated, and the plan's effect on your automobile rate in the event of a chargeable accident(s) and/or conviction. What is the Safe Driver Insurance Plan? The Safe Driver Insurance Plan (hereafter referred to as SDIP) uses past experience (accidents & convictions) as part of the determination of your premium cost. The system described below has been established under which those drivers that have no points receive the lowest premiums. Higher premiums are charged for other drivers based upon the number of points they have accumulated during the experience period. The experience period shall be the three years immediately preceding the date of application or the preparation of the renewal. Premiums for the following coverages are affected: Liability, Benefits and Coverage for To Your Auto. Driving Record A. CHARGEABLE ACCIDENTS shall be assigned for each at fault accident that occurred during the experience period, involving the applicant or any current resident operator, while operating an auto. For all accidents $,0 or greater in excess of any self insured retention or deductible applicable to the named insured and occurred after July, 00 but before July, 008: One point is assigned for each accident for which an insurer paid a claim during the experience period of $,0 or more. One point is assigned for one or more accidents for which an insurer paid an aggregate amount of $,0 or more in the experience period. For all accidents $,0 or greater in excess of any self insured retention or deductible applicable to the named insured and occurred after July, 008 but before July, 0: One point is assigned for each accident for which an insurer paid a claim during the experience period of $,0 or more. One point is assigned for one or more accidents for which an insurer paid an aggregate amount of $,0 or more in the experience period. For all accidents $,0 or greater in excess of any self insured retention or deductible applicable to the named insured and occurred after July, 0: One point is assigned for each accident for which an insurer paid a claim during the experience period of $,0 or more. One point is assigned for one or more accidents for which an insurer paid an aggregate amount of $,0 or more in the experience period. B. CONVICTIONS shall be assigned for convictions during the experience period for motor vehicle violations of the applicant or any other named insured, or current resident operator as follows:. Six points shall be assigned for conviction of: a. Driving while intoxicated or under the influence of drugs; or b. Failure to stop and report when involved in an accident; or c. Evading police; or d. Homicide or assault arising out of the operation of a motor vehicle; or e. Use of a vehicle in the commission of a felony; or f. Reckless or negligent operation of a motor vehicle; or g. Driving with a license that is suspended or revoked; or h. Operating a vehicle without permission; or i. Lending a license or registration to another; or AU PA0d 0 Page of

2 GENERAL GENERAL GE j. Misrepresentation or making false statements to obtain a license, registration or insurance; or k. Failure to submit to a chemical test; or l. Driving while drinking an open container.. Four conviction points shall be assigned for conviction of: a. Racing on a public highway; or b. Any violation resulting in injury or death; or c. Permitting an uninsured vehicle to be driven; or d. Permitting an unlicensed individual to drive; or e. Driving without a valid license.. Two conviction points shall be assigned for convictions of driving MPH or more in excess of the posted speed limit.. One conviction point shall be assigned for convictions of any other civil infraction for a moving vehicle violation.. Six points for suspension of license unless resulting from any of the conviction contained in above subsection () or (). Exception: A surcharge is not charged for the first one or two point conviction listed in this rule in the experience period. C. EXCEPTIONS. No points are assigned for accidents incurred by an operator demonstrated to be a named insured or a principal operator of an auto insuredunderaseparatepolicy;and. No points are assigned for accidents occurring under the following circumstances: a. auto lawfully parked (if the parked vehicle rolls from the parked position then any such accident is charged to the person who parked the auto); or b. the insured, or owner of the motor vehicle, is reimbursed by, or on behalf of, a person who is responsible for the accident or has judgment against such person; or c. auto is struck in the rear by another vehicle and the insured has not been convicted of a moving traffic violation in connection with this accident; or d. the operator of the other auto involved in the accident was convicted of a moving violation and the insured was not convicted of a moving traffic violation in connection with the accident; or e. auto operated by the applicant or any resident operator is struck by a "hit and run" vehicle, if the accident is reported to the proper authority within hours by the applicant or resident operator; or f. accidents involving damage by contact with animals or fowl; or g. accidents involving physical damage, limited to and caused by flying gravel, missiles, or falling objects; or h. accidents occurring when using the auto in response to an emergency if the insured at the time of the accident was a paid or volunteer member of any Police or Fire Department, First Aid Squad, or any law enforcement agency. This exception does not include an accident occurring after the auto ceases to be used in response to such emergency; or i. accidents resulting in an insurer paying a Medical claim; or j. accidents where the insurer is reimbursed by or on behalf of the named insured or other resident operator for or more of the total amount of the paid claim received through subrogation or from a settlement or judgment against the individual responsible for the accident; or k. payment of a claim made under the comprehensive portion of the policy unless the loss was intentionally caused by the insured. AU PA0d 0 Page of

3 . An accident incurred by an operator who is demonstrated to no longer reside in the insured's household is not eligible for surcharge. GENERAL GENERAL GE Point & Surcharge Calculation 90% 8 0 8% 9 % 0% % % 8% Percentage Increase of the Premium Single 90% 8 0 8% 9 % 0% % % 8% 00% Multi * 00% % 8% 0% % 8% The following show the conviction surcharge as a percentage of the base premium: Percentage Increase of the Premium Single The number of accident points in combination with the conviction points determines the surcharge. The following shows the accident surcharge as a percentage of the overall premium: 0% 90% 00% 00% 800% 8% 00% % 8% 00% AU PA0d 0 Page of

4 Multi * GENERAL GENERAL GE 8% % 8% % % 0% % 8% % 8% % 8% % *With two s, this surcharge applies to each car. If there are more than two cars, it applies to the two cars with the highest premium, usually the highest valued cars. ** EXCESS CONVICTION OR ACCIDENT POINTS: For each Conviction Point in excess of 8 or each Point in excess of 8, increase the applicable 8 Point Conviction Factor or 8 Point Factor by the following Additional Factor. For Each Excess: Point Single Multi Code Medical Expenses 00% 0 % % Single Multi % % % Conviction Point Code These percentage surcharges are illustrative of the effect on the base premium only. While the base premium is different depending upon rating territory, the base premium does not vary for other considerations such as your age, sex, or marital status. However, the percentage of surcharge when compared to your total premium, which does recognize among other things your age, marital status and rate level tier, could vary somewhat from the above cited percentages. You may be able to determine the points assigned to you by looking at your policy. The front page information may include a six digit code such as IKND. The fifth position represents the number of accidents, one in this case. The sixth position represents the number of convictions, two convictions in this example. If the last two positions of the code are "00", no surcharge is applied to your policy. For more information about these surcharges, please contact your agent or company. AU PA0d 0 Page of

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