/ Filing at a Glance Company: Star Insurance Company Star-General-Auto-Composite SERFF Tr Num: MEAD-126985694 State: Wisconsin Per Unit-0111 TOI: 20.0 Commercial Auto SERFF Status: Closed-Filed State Tr Num: Sub-TOI: 20.0000 Commercial Auto Co Tr Num: STAR-GENERAL- State Status: Combinations AUTO-COMPOSITE PER UNIT- 0111 Filing Type: Form Reviewer(s): Rachel Donohue Author: Louis Sugarman Disposition Date: 01/24/2011 Date Submitted: 01/18/2011 Disposition Status: Filed Effective Date Requested (New): On Approval Effective Date (New): Effective Date Requested (Renewal): On Approval Effective Date (Renewal): General Information Project Name: Status of Filing in Domicile: Authorized Project Number: Domicile Status Comments: Desk-filed in domicile Michigan. Reference Organization: Reference Number: Reference Title: Advisory Org. Circular: Filing Status Changed: 01/24/2011 State Status Changed: Deemer Date: 02/16/2011 Created By: Louis Sugarman Submitted By: Louis Sugarman Corresponding Filing Tracking Number: Filing Description: Dear Sir or Madam: Star Insurance Company (Star) writes commercial insurance in your state, Star is a member of Insurance Services Office (ISO), and Star has authorized ISO to file forms and rules on our behalf. We write commercial auto insurance in your state. We hereby file the enclosed endorsement 5175 CA 0111 Composite Rating - Per Unit Basis. This filing is made on a file and use basis.
/ Sincerely, Louis Sugarman Senior Compliance Analyst Star Insurance Company 248-204-8228 Company and Contact Filing Contact Information Louis Sugarman, Sr. Compliance Analyst lsugarman@meadowbrook.om 26255 American Drive 248-204-8228 [Phone] Southfield, MI 48034 248-358-1614 [FAX] Filing Company Information Star Insurance Company CoCode: 18023 State of Domicile: Michigan 26255 American Drive Group Code: 748 Company Type: property and casualty Southfield, MI 48034 Group Name: Meadowbrook State ID Number: (248) 358-1100 ext. [Phone] FEIN Number: 38-2626205 --------- Filing Fees Fee Required? Retaliatory? Fee Explanation: Per Company: No No No COMPANY AMOUNT DATE PROCESSED TRANSACTION # Star Insurance Company $0.00
Correspondence Summary / Dispositions Status Created By Created On Date Submitted Filed Rachel Donohue 01/24/2011 01/24/2011
Disposition / Disposition Date: 01/24/2011 Effective Date (New): Effective Date (Renewal): Status: Filed Comment: Used with form filings that are subject to file & use under s. 631.20(1)(c) and (1m) Wis. Stat. Effective July 1st, 2008, changes in insurance law exempted certain policy forms from receiving prior approval before use. This filing may be used 30 days after receipt by OCI. USE DATE: 02/16/2011 Rate data does NOT apply to filing.
/ Schedule Schedule Item Schedule Item Status Public Access Supporting Document Certification of Compliance Filed Yes Supporting Document Appraisal or Arbitration Provision Filed Yes Form Composite Rating - Per Unit Basis Filed Yes
Form Schedule / Schedule Form Name Form # Edition Form Type Action Action Specific Readability Attachment Item Status Date Data Filed Composite Rating5175 CA 0111 Endorseme New 0.000 5175 CA 01/24/2011 - Per Unit Basis nt/amendm ent/conditi ons 0111 Composite Rating - Per Unit Basis.pdf
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMPOSITE RATING PER UNIT BASIS This endorsement modifies insurance provided under the following policies: TRUCKERS DECLARATIONS CA DS 14 MOTOR CARRIER DECLARATIONS CA DS 21 Item Seven of the Declarations is replaced with the following: ITEM SEVEN It is understood and agreed that the premium for this Coverage Form is based on the number of auto units as shown in the Schedule and defined below. SCHEDULE Number of Units: Estimated Annual Premium:: $ Rate Per Unit (annual premium divided by units): $ Minimum Annual Premium: $ Minimum Monthly Premium: $ Deposit Premium: $ 1. A monthly report of all units covered and premium payment is due by the 15 th of the month following the month for which the report is due. 2. Application of the Minimum Monthly Premium will not serve to increase the Minimum Annual Premium. 3. When used as a premium basis: Unit means a covered auto as defined in the policy, and subject to the policy terms and conditions. 4. We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three (3) years afterward. All other policy terms, conditions, definitions and exclusions remain unchanged. 5175 CA 0111 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
Rate Information / Rate data does NOT apply to filing.
/ Supporting Document Schedules Item Status: Status Date: Satisfied - Item: Certification of Compliance Filed 01/24/2011 Comments: Attachment: WI Certificate of Compliance.pdf Item Status: Status Date: Bypassed - Item: Appraisal or Arbitration Provision Filed 01/24/2011 Bypass Reason: N/A. Comments: