/ Filing at a Glance Companies: American Zurich Insurance Company, American Guarantee and Liability Insurance Company, Zurich American Insurance Company of Illinois, Zurich American Insurance Company Contractor/ Owner Controlled SERFF Tr Num: ZURC-126101289 State: Wisconsin Insurance Program - Construction (Wrap-Up) TOI: 17.0 Other Liability-Occ/Claims Made SERFF Status: Closed State Tr Num: Sub-TOI: 17.0001 Commercial General Liability Co Tr Num: State Status: Filing Type: Rate/Rule Co Status: Not Applicable Reviewer(s): Stephanie Cook Author: Cindy Schultz Disposition Date: 04/07/2009 Date Submitted: 04/07/2009 Disposition Status: Filed Effective Date Requested (New): 05/01/2009 Effective Date (New): Effective Date Requested (Renewal): 05/01/2009 Effective Date (Renewal): General Information Project Name: Contractor/ Owner Controlled Insurance Program - Construction (Wrap-Up) Project Number: Reference Organization: Reference Title: Filing Status Changed: 04/07/2009 State Status Changed: Corresponding Filing Tracking Number: Status of Filing in Domicile: Domicile Status Comments: Reference Number: Advisory Org. Circular: Deemer Date: Filing Description: In accordance with the filing requirements of your state, we submit for your review and approval two new usage rules to be used on a mandatory basis with all our wrap-up programs around the country. Rule 16 - Additional Interests -U-GL-1379, Named Insured Owner Controlled Insurance Program, will be issued with all owner controlled insurance programs. Rule 16 - Additional Interests - U-GL-1380, Named Insured Contractor Controlled Insurance Program, will be issued with all contractor controlled insurance programs.
/ Both endorsements modify Section II Who Is An Insured to include the wrap up programs' enrolled contractors performing work at the "designated project". These endorsements further explain who is NOT an insured under the policy. There is no premium consideration associated with either endorsement. Company and Contact Filing Contact Information Cindy Schultz, Filing Analyst cindy.schultz@zurichna.com 1400 American Lane (847) 762-7311 [Phone] Schaumburg, IL 60196 (847) 605-7768[FAX] Filing Company Information American Zurich Insurance Company CoCode: 40142 State of Domicile: Illinois 1400 American Lane Group Code: 212 Company Type: Schaumburg, IL 60196 Group Name: State ID Number: (847) 605-6000 ext. [Phone] FEIN Number: 36-3141762 --------- American Guarantee and Liability Insurance CoCode: 26247 State of Domicile: New York Company 1400 American Lane Group Code: 212 Company Type: Schaumburg, IL 60196 Group Name: State ID Number: (847) 605-6000 ext. [Phone] FEIN Number: 36-6071400 --------- Zurich American Insurance Company of Illinois CoCode: 27855 State of Domicile: Illinois 1400 American Lane Group Code: 212 Company Type: Schaumburg, IL 60196 Group Name: State ID Number: (847) 605-6000 ext. [Phone] FEIN Number: 36-2781080 --------- Zurich American Insurance Company CoCode: 16535 State of Domicile: New York 1400 American Lane Group Code: 212 Company Type: Schaumburg, IL 60102 Group Name: State ID Number:
/ (847) 605-6000 ext. [Phone] FEIN Number: 36-4233459 ---------
Filing Fees / Fee Required? Retaliatory? Fee Explanation: Per Company: No No No COMPANY AMOUNT DATE PROCESSED TRANSACTION # American Zurich Insurance Company $0.00 American Guarantee and Liability Insurance $0.00 Company Zurich American Insurance Company of Illinois $0.00 Zurich American Insurance Company $0.00
Correspondence Summary / Dispositions Status Created By Created On Date Submitted Filed Shasta Hoffhein 04/07/2009 04/07/2009
Disposition / Disposition Date: 04/07/2009 Effective Date (New): Effective Date (Renewal): Status: Filed Comment: Filed is used with rates, rules and advertisements. Rate data does NOT apply to filing. Overall Rate Information for Multiple Company Filings Overall Percentage Rate Indicated For This Filing 0.000% Overall Percentage Rate Impact For This Filing 0.000% Effect of Rate Filing-Written Premium Change For This Program $0 Effect of Rate Filing - Number of Policyholders Affected 0
/ Item Type Item Name Item Status Public Access Supporting Document Rate Filed Yes Supporting Document Rule Filed Yes Rate Additional Interests - Named Insured - Filed Owner Controlled Insurance Program - U- GL-1379 Rate Additional Interests - Named Insured - Contractor Controlled Insurance Program - U-GL-1380 Filed Yes Yes
Rate Information / Rate data does NOT apply to filing.
Rate/Rule Schedule / Review Status: Exhibit Name: Rule # or Page Rate Action Previous State Filing Attachments #: Number: Filed Additional Interests - Named Insured - Owner Controlled Insurance Program - U-GL-1379 16 New Rule 16 1379.pdf Filed Additional Interests - Named Insured - Contractor Controlled Insurance Program - U-GL-1380 16 New Rule 16 1380.pdf
1/2009 Document Edition SECTION I GENERAL RULES COMMERCIAL LINES MANUAL DIVISION SIX - COMMERCIAL GENERAL LIABILITY EXCEPTION PAGE COUNTRYWIDE RULE 16. ADDITIONAL INTERESTS Section A No Additional Charge - is amended to include the following: U-GL-1379 Named Insured Owner Controlled Insurance Program A. Use Named Insured Owner Controlled Insurance Program, form U-GL-1379, to include a contractor as a named insured subject to the contingencies as outlined in the form. B. This is a mandatory endorsement which must be used with all wrap up programs which are controlled by the owner. C. There is no premium consideration for this endorsement.
1/2009 Document Edition SECTION I GENERAL RULES COMMERCIAL LINES MANUAL DIVISION SIX - COMMERCIAL GENERAL LIABILITY EXCEPTION PAGE COUNTRYWIDE RULE 16. ADDITIONAL INTERESTS Section A No Additional Charge - is amended to include the following: U-GL-1380 Named Insured Contractor Controlled Insurance Program A. Use Named Insured Contractor Controlled Insurance Program, form U-GL-1380, to include a contractor as a named insured subject to the contingencies as outlined in the form. B. This is a mandatory endorsement which must be used with all wrap up programs which are controlled by the contractor. C. There is no premium consideration for this endorsement.
/ Supporting Document Schedules Review Status: Bypassed -Name: Rate Filed 04/07/2009 Bypass Reason: N/A Comments: Review Status: Bypassed -Name: Rule Filed 04/07/2009 Bypass Reason: N/A Comments: