SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS

Transcription

1 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Filing at a Glance Company: Product Name: State: TOI: Sub-TOI: Filing Type: United Ohio Insurance Company Personal Automobile New Hampshire 19.0 Personal Auto Private Passenger Auto (PPA) Form Date Submitted: 06/12/2013 SERFF Tr Num: SERFF Status: State Tr Num: State Status: Co Tr Num: Effective Date Requested (New): Effective Date Requested (Renewal): Author(s): Reviewer(s): OHMG Closed-Approved 07/17/2013 FJC Approved 2013 AMSNH FORMS 09/16/ /16/2014 Disposition Date: 07/17/2013 Disposition Status: Sam Michener, Sabrina Wang, Judy Perrin, Barbara Harper Frank Cardamone (primary), Steve Towne Approved Effective Date (New): 10/15/2013 Effective Date (Renewal): 10/15/2014 PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

2 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms General Information Project Name: Introduction of a new AMS product Project Number: 2013 AMSNH Forms Reference Organization: Reference Title: Filing Status Changed: 07/17/2013 State Status Changed: 07/17/2013 Created By: Barbara Harper Corresponding Filing Tracking Number: OHMG Status of Filing in Domicile: Domicile Status Comments: Reference Number: Advisory Org. Circular: Deemer Date: Submitted By: Barbara Harper Filing Description: We are filing our United Ohio Insurance Company Masters Series personal automobile program that includes a new personal automobile rating product. The new business effective date for this filing is 09/16/2013. Please see the attached Filing Memorandum for complete details. The corresponding Rate/Rule filing has been filed under OHMG Company and Contact Filing Contact Information Barbara Harper, Sr Product Analyst P O Box 111 Bucyrus, OH Filing Company Information United Ohio Insurance Company P O Box 111 Bucyrus, OH (419) ext. [Phone] bharper@omig.com [Phone] CoCode: Group Code: Group Name: 0963 FEIN Number: State of Domicile: Ohio Company Type: Property & Casualty State ID Number: Filing Fees Fee Required? State Specific Yes Fee Amount: $20.00 Retaliatory? Yes Fee Explanation: Retaliatory Filing Fee = $20.00 Per Company: Yes Company Amount Date Processed Transaction # United Ohio Insurance Company $ /12/ United Ohio Insurance Company $ /12/ PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

3 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Have you viewed and complied with New Hampshire's General Instructions and Filing Requirements (Yes/No)? *Failure to comply will result in a filing rejection and require resubmission.: Yes PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

4 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Correspondence Summary Dispositions Status Created By Created On Date Submitted Approved Frank Cardamone 07/17/ /17/2013 Objection Letters and Response Letters Objection Letters Response Letters Status Created By Created On Date Submitted Responded By Created On Date Submitted Awaiting Frank Cardamone 07/02/ /02/2013 Barbara Harper 07/12/ /12/2013 Company Reply Amendments Schedule Schedule Item Name Created By Created On Date Submitted Form Personal Auto Policy Barbara Harper 06/12/ /12/2013 Form Extended Non-Owned Coverage For Named Individual Barbara Harper 06/12/ /12/2013 Form Adverse Action Letter Barbara Harper 06/12/ /12/2013 Filing Notes Subject Note Type Created By Created On Date Submitted Effective date change Note To Filer Frank Cardamone 09/10/ /10/2013 Change of Effective Dates Note To Reviewer Barbara Harper 09/05/ /05/2013 Initial Intake Review - Awaiting Fee Note To Filer Jennifer Goodwin 06/12/ /12/2013 PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

5 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Disposition Disposition Date: 07/17/2013 Effective Date (New): 10/15/2013 Effective Date (Renewal): 10/15/ Effective Date (New) changed from 09/16/2013 to 10/15/2013 and Effective Date (Renewal) changed from 09/16/2014 to 10/15/2014 by Cardamone, Frank on 09/10/2013. Status: Approved Comment: Rate data does NOT apply to filing. Schedule Schedule Item Schedule Item Status Public Access Supporting Document Filing Memorandum Completed Review Yes Supporting Document NH Retaliatory Fees Yes Supporting Document Underwriting Guidelines-Personal Lines Rate Filings Yes Form (revised) Personal Auto Policy Completed Review Yes Form (revised) Named Driver Exclusion Completed Review Yes Form Miscellaneous Type Vehicle Endorsement Completed Review Yes Form Additional Insured - Lessor Completed Review Yes Form Classic Auto Coverage Completed Review Yes Form Antique Automobile Endorsement Completed Review Yes Form Auto Plus Endorsement Completed Review Yes Form Trust Endorsement Completed Review Yes Form Additional Insured - Owner/Titleholder Completed Review Yes Form Low Speed Vehicle Endorsement Completed Review Yes Form (revised) Extended Non-Owned Coverage For Named Individual Completed Review Yes Form Named Non-Owner Coverage Completed Review Yes Form (revised) Named Driver Exclusion Form Completed Review Yes Form (revised) Adverse Action Letter Completed Review Yes Form US Treasury Department's Office of Foreign Asset Control Completed Review Yes (OFAC) Advisory Notice to Policyholders Form Officer's Signature Completed Review Yes PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

6 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Schedule Schedule Item Schedule Item Status Public Access Form Notice Of Company Information Practices Completed Review Yes Form Declaration Page Completed Review Yes Form Cancellation Notice - All Other Reasons Completed Review Yes Form Cancellation Notice - Nonpayment of Premium Completed Review Yes Form Nonrenewal Notice Completed Review Yes Form Pending Cancellation Notice Completed Review Yes Form Personal Auto Policy Informational Yes Form Named Driver Exclusion Informational Yes Form Extended Non-Owned Coverage For Named Individual Informational Yes Form Named Driver Exclusion Form Informational Yes Form Adverse Action Letter Informational Yes PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

7 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Objection Letter Objection Letter Status Objection Letter Date 07/02/2013 Submitted Date 07/02/2013 Respond By Date 07/17/2013 Dear Barbara Harper, Introduction: Awaiting Company Reply After review of this filing, we have the following question(s)/comment(s). Objection 1 - Named Driver Exclusion, A-101-NH, (08-13) (Form) Comments: Driver exclusions are permitted in New Hampshire, however, you are still required to provide minimum Financial Responsibility Limits, even if an excluded driver is operating a covered automobile with permission. Driver Exclusions must be limited to the excluded driver's exposure. The exposure named in the exclusion may not be cause for limiting the interests of the owner or any passengers should a claim occur. RSA 264:18 III explains that a motor vehicle liability policy is absolute up to the minimum Financial Responsibility Limits of $25,000/$50,000/$25,000. Objection 2 - Named Non-Owner Coverage, A-397, (12-10) (Form) Comments: Please clarify how this endorsement would be utilized. Anyone operating an insured vehicle with permission of the insured should be covered by this policy. Conclusion: Review will continue when we receive your reply. In the absence of any response by the Respond-By-Date noted above, this filing will be disapproved. Extensions will not be granted without good cause shown, RSA 400-A:16 II. Sincerely, Frank Cardamone PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

8 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Response Letter Response Letter Status Submitted to State Response Letter Date 07/12/2013 Submitted Date 07/12/2013 Dear Frank Cardamone, Introduction: In response to your 07/01/2013 Objection Letter we offer the following: Response 1 Comments: To ensure compliance with the NH Statutes, we have revised and replaced the Named Driver Exclusion (Form) A-101 NH. In addition, as a result of the changes to Form A-101 NH, we have updated Form CEF-286 NH to coordinate with the revised A-101 NH. Form CEF-286 NH is actually the form that is used to be signed by the insured for the named driver exclusion. Thank you for bringing Statute RSA 264:18 III to our attention. Related Objection 1 Applies To: - Named Driver Exclusion, A-101-NH, (08-13) (Form) Comments: Driver exclusions are permitted in New Hampshire, however, you are still required to provide minimum Financial Responsibility Limits, even if an excluded driver is operating a covered automobile with permission. Driver Exclusions must be limited to the excluded driver's exposure. The exposure named in the exclusion may not be cause for limiting the interests of the owner or any passengers should a claim occur. RSA 264:18 III explains that a motor vehicle liability policy is absolute up to the minimum Financial Responsibility Limits of $25,000/$50,000/$25,000. Changed Items: No Supporting Documents changed. PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

9 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: Product Name: Project Name/Number: Form Schedule Item Changes Item No. Form Name 1 Named Driver Exclusion Previous Version 1 Named Driver Exclusion 2 Named Driver Exclusion Form Form Number Edition Date Form Type Form Action Action Specific Readability Score Attachments Submitted Data A-101-NH (08-13) END New A-101-NH (08-13) Named Driver Exclusion (NH) chgd pdf A-101-NH (08-13) END New A-101-NH (08-13) Named Driver Exclusion _NH_.pdf CEF-286-NH (08-13) END New CEF-286-NH (08-13) Named Driver Exclusion Form - Personal Auto Policies (NH) chgd pdf Date Submitted: 07/12/2013 By: Barbara Harper Date Submitted: 06/12/2013 By: Barbara Harper Date Submitted: 07/12/2013 By: Barbara Harper Previous Version 2 Named Driver CEF-286-NH (08-13) END New CEF-286-NH Date Submitted: Exclusion Form (08-13) Named 06/12/2013 Driver By: Barbara Exclusion Form Harper - Personal Auto Policies (NH).pdf No Rate/Rule Schedule items changed. Response 2 Comments: 19.0 Personal Auto/ Private Passenger Auto (PPA) Personal Automobile Introduction of a new AMS product/2013 AMSNH Forms PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

10 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms The A-397 allows an individual that does not own a vehicle to purchase a policy providing coverage when driving a vehicle they do not own, such as a rental vehicle. If an individual does not own a vehicle and they rent a vehicle on a regular basis, they may want to purchase this coverage versus purchasing coverage from the rental car company. Related Objection 2 Applies To: - Named Non-Owner Coverage, A-397, (12-10) (Form) Comments: Please clarify how this endorsement would be utilized. Anyone operating an insured vehicle with permission of the insured should be covered by this policy. Changed Items: No Supporting Documents changed. No Form Schedule items changed. No Rate/Rule Schedule items changed. Conclusion: We trust that with these changes and explanations, you will be in a position to complete your review and we await your approval. Thank you and have a great weekend. Sincerely, Barbara Harper PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

11 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Amendment Letter Submitted Date: 06/12/2013 Comments: In response to your Note to Filer, we offer the following: 1) An additional $30.00 has been added to the Filing Fee Tab. We apologize for not including the correct amount with the initial filing 2) Form numbers 1 and 14 have been updated to include the form number on every page. Form numbers 19, 20, 21 and 22 are considered to be deactivation notices. As such, these forms are always printed as "duplex". There is never an occurrence where the insured would not realize that this is one form. Therefore, we are asking you to respectfully reconsider your decision to request the form number on every page. 3) The edition date on Form number 11 has been changed to match the actual form. This was a typo on my part. We trust that with these changes you can continue your review of this submission. Thank you. Changed Items: PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

12 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: Product Name: Project Name/Number: Form Schedule Item Changes Item No. Form Name 1 Personal Auto Policy Previous Version 1 Personal Auto Policy 2 Extended Non- Owned Coverage For Named Individual Previous Version 2 Extended Non- Owned Coverage For Named Individual 3 Adverse Action Letter Previous Version 3 Adverse Action Letter Form Number No Rate Schedule Items Changed Personal Auto/ Private Passenger Auto (PPA) Personal Automobile Introduction of a new AMS product/2013 AMSNH Forms Edition Date Form Type Form Action Action Specific Readability Score Attachments Submitted Data A-10-NH (08-13) PCF New A-10-NH (08-13) Personal Auto Policy Wording.pdf A-10-NH (08-13) PCF New A-10-NH (08-13) Personal Auto Policy Wording.pdf A-396 (11-93) END New A-396 (11-93) Extended Non- Owned Coverage for Named Individiual.pdf Date Submitted: 06/12/2013 By: Date Submitted: 06/12/2013 By: Barbara Harper Date Submitted: 06/12/2013 By: A-396 (11-91) END New A-396 (11-93) Extended Non- Owned Coverage for Named Individiual.pdf Date Submitted: 06/12/2013 By: Barbara Harper CEF-357 (03-13) DSC New CEF-357 (03-13) 2013 Adverse Action Letter (OH-IN- ME-NH-VT).pdf Date Submitted: 06/12/2013 By: CEF-357 (03-13) DSC New CEF-357 (03-13) 2013 Date Submitted: 06/12/2013 Adverse Action By: Barbara Letter (OH-IN- Harper ME-NH-VT).pdf No Supporting Documents Changed. PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

13 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

14 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Note To Filer Created By: Frank Cardamone on 09/10/ :09 AM Last Edited By: Filing Rules Migration Submitted On: 10/15/ :01 AM Subject: Effective date change Comments: Per your request the effective dates have been amended to 10/15/2013 PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

15 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Note To Reviewer Created By: Barbara Harper on 09/05/ :50 AM Last Edited By: Filing Rules Migration Submitted On: 10/15/ :01 AM Subject: Change of Effective Dates Comments: Upon further consideration and system constraints, Management has decided to change the effective dates for this approved filing as follows: New Business - From all new business policies effective on or after 09/16/2013 TO all new business policies effective on or after 10/15/2013. Renewals - From all renewal policies effective on or after 09/16/2014 TO all renewal policies effective on or after 10/15/2014. Your acknowledgement of this effective date change would be greatly appreciated. Thank you. PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

16 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Note To Filer Created By: Jennifer Goodwin on 06/12/ :43 AM Last Edited By: Filing Rules Migration Submitted On: 10/15/ :01 AM Subject: Initial Intake Review - Awaiting Fee Comments: During the initial intake review the following has been discovered: 1) Ohio requires a $50 fee, please remit the remaining $30 via EFT by 06/14/2013 4:00pm eastern time. 2) Form numbers 1, 14, 19, 20, 21, and 22 need to have the form number on every page. 3) Form number 11 the edition date does not match the edition date on the form schedule tab. Please correct. Thank You. If you are unable to make the necessary change(s), a request to withdraw must be received otherwise this filing will be rejected. A rejected filing would require a resubmission with corrections along with filing fees. In order for NHID to resume the review of your filing, the noted revision(s) must be received on or before 06/14/2013 4:00 PM Eastern Time. PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

17 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Form Schedule Item Schedule Item No. Status 1 Completed Review 07/02/ Completed Review 07/17/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/2013 Form Form Edition Form Form Action Specific Readability Name Number Date Type Action Data Score Attachments Personal Auto Policy A-10-NH (08-13) PCF New A-10-NH (08-13) Personal Auto Policy Wording.pdf Named Driver Exclusion A-101-NH (08-13) END New A-101-NH (08-13) Named Driver Exclusion (NH) chgd pdf Miscellaneous Type Vehicle Endorsement A-125-NH (08-13) END New A-125-NH (08-13) Miscellaneous Type Vehicle Endorsement (PPA ONLY).pdf Additional Insured - Lessor A-131 (10-06) END New A-131 (10-06) Additional Insured - Lessor.pdf Classic Auto Coverage A-140 (10-06) END New A-140 (10-06) Classic Auto Coverage End.pdf Antique Automobile Endorsement A-145 (10-06) END New A-145 (10-06) Antique Automobile End.pdf Auto Plus Endorsement A-150 (12-10) END New A-150 (12-10) Auto Plus Coverage Endorsement.pdf Trust Endorsement A-155 (10-06) END New A-155 (10-06) Trust Endorsement.pdf Additional Insured - Owner/Titleholder A-165 (06-10) END New A-165 (06-10) Additional Insured - Owner- Titleholder.pdf PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

18 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Item Schedule Item No. Status 10 Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/17/ Completed Review 07/17/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/2013 Form Name Low Speed Vehicle Endorsement Extended Non-Owned Coverage For Named Individual Named Non-Owner Coverage Named Driver Exclusion Form Form Edition Form Form Action Specific Readability Number Date Type Action Data Score Attachments A-170-NH (08-13) END New A-170-NH (08-13) Low Speed Vehicle Endorsement- New Hampshire (NH).pdf A-396 (11-93) END New A-396 (11-93) Extended Non- Owned Coverage for Named Individiual.pdf A-397 (12-10) END New A-397 (12-10) Named Non- Owner Coverage.pdf CEF-286- NH (08-13) END New CEF-286-NH (08-13) Named Driver Exclusion Form - Personal Auto Policies (NH) chgd pdf Adverse Action Letter CEF-357 (03-13) DSC New CEF-357 (03-13) 2013 Adverse Action Letter (OH-IN-ME-NH- VT).pdf US Treasury Department's Office of Foreign Asset Control (OFAC) Advisory Notice to Policyholders IL P DSC New IL P 001 (01-04) U.S. Treas. Dept. Office of Foreign Assets Control (OFAC) Advisory Notice to Policyholders.pdf Officer's Signature SIG-1 (01-12) OTH New SIG-1 (01-12) Signature Page.pdf PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

19 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Item Schedule Item No. Status 17 Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/ Completed Review 07/02/2013 Form Name Notice Of Company Information Practices Form Edition Form Form Action Specific Readability Number Date Type Action Data Score Attachments UOI-101 (01-12) DSC New UOI-101 (01-12) Notice of Company Information Practices (HMS- ME,NH).pdf Declaration Page APCDEC DEC New AMS Dec Page.pdf Cancellation Notice - All Other Reasons Cancellation Notice - Nonpayment of Premium CEF-345 (01-12) CNR New AMS Final Cancellation - All Other Reasons 2.pdf CEF-353 (02-13) CNR New AMS Final Cancellation - Nonpayment 2.pdf Nonrenewal Notice CEF-346 (01-12) CNR New AMS Nonrenewal - 2.pdf Pending Cancellation Notice CEF-352 (02-13) CNR New AMS Pending Cancellation - 2.pdf Form Type Legend: ABE Application/Binder/Enrollment ADV Advertising BND Bond CER Certificate CNR Canc/NonRen Notice DEC Declarations/Schedule DSC Disclosure/Notice END Endorsement/Amendment/Conditions ERS Election/Rejection/Supplemental Applications OTH Other PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

20 POLICY The attached Declarations and the pages that follow describe the auto insurance protection you have purchased through your insurance agent. While it is our intent to provide a policy that is readable and easy to understand, your agent will welcome any questions that you may have regarding your policy.

21 YOUR GUIDE TO PROTECTION Beginning On Page AGREEMENT... 1 DEFINITIONS... 1 PART A - LIABILITY COVERAGE Insuring Agreement... 2 Supplementary Payments... 2 Exclusions... 3 Limit of Liability... 4 Out of State Coverage... 5 Financial Responsibility... 5 Other Insurance... 5 PART B - MEDICAL PAYMENTS COVERAGE Insuring Agreement... 5 Exclusions... 6 Limit of Liability... 6 Other Insurance... 7 PART C - UNINSURED MOTORISTS AND UNDERINSURED MOTORISTS COVERAGE Insuring Agreement... 7 Exclusions... 8 Limit of Liability... 9 Action Against the Company... 9 Other Insurance Arbitration Additional Duty After an Accident or Loss PART D - COVERAGE FOR DAMAGE TO YOUR AUTO Insuring Agreement Transportation Expenses Camping Vehicles - Awning Camping Vehicles - Contents Personal Effects Exclusions Limit of Liability Payment of Loss Loss Payable Clause Beginning On Page No Benefit to Bailee Other Sources of Recovery Appraisal PART E - OPTIONAL COVERAGES Insuring Agreement Accidental Death Coverage Broad Form Collision Coverage Broad Form Glass Difference in Value Coverage for Loan/ Lease Autos Excess Electronic Equipment Coverage Optional Limits Transportation Expenses Coverage Repair or Replacement Coverage Tapes, Records, Disks, or Other Media Only Coverage Towing and Labor Coverage Trip Interruption Coverage PART F - DUTIES AFTER AN ACCIDENT OR LOSS General Duties PART G - GENERAL POLICY PROVISIONS Bankruptcy Changes Fraud Legal Action Against Us Our Right to Recover Payment Our Right to Recover Earned Premium Policy Period and Territory Termination Conformity to Statute Transfer of Your Interest in This Policy Two or More Auto Policies... 22

22 A-10-NH (08-13) PERSONAL AUTO POLICY AGREEMENT In return for payment of the premium and subject to all the terms of this policy, we agree with you as follows: DEFINITIONS A. Throughout this policy, "you" and "your refer to: 1. The "named insured" shown in the Declarations; and 2. The spouse if a resident of the same household. If the spouse ceases to be a resident of the same household during the policy period or prior to the inception of this policy, the spouse will be considered "you" and "your" under this policy but only until the earlier of: 1. The end of 90 days following the spouse's change of residency; 2. The effective date of another policy listing the spouse as a named insured; or 3. The end of the policy period. B. "We", "us", and "our" refer to the Company providing this insurance. C. For purposes of this policy, a private passenger type auto, pickup, or van shall be deemed to be owned by a person if leased: 1. Under a written agreement to that person; and 2. For a continuous period of at least six months. Other words and phrases are defined. They are in quotation marks when used. D. "Bodily injury" means bodily harm, sickness, or disease, including death that results. E. "Business" includes trade, profession, or occupation whether full- or part-time. F. "Family member" means a person related to you by blood, marriage, or adoption who is a resident of your household. This includes a ward or foster child. G. "Occupying" means: 1. In; 2. Upon; or 3. Getting in, on, out, or off. H. "Property damage" means physical injury to, destruction of, or loss of use of tangible property. I. "Trailer" means a vehicle designed to be pulled by a: 1. Private passenger auto; or 2. Pickup or van. It also means a farm wagon or farm implement while towed by a vehicle listed in 1. or 2. above. J. "Your covered auto" means: 1. Any vehicle shown in the Declarations. 2. A "newly acquired auto". 3. Any "trailer" you own. 4. Any auto or "trailer" you do not own while used as a temporary substitute for any other vehicle described in this definition which is out of normal use because of its: a. Breakdown; b. Repair; c. Servicing; d. Loss; or e. Destruction. This provision (J.4.) does not apply to Coverage for Damage to Your Auto. K. "Newly acquired auto": 1. "Newly acquired auto" means any of the following types of vehicles you become the owner of during the policy period: a. A private passenger auto; or b. A pickup or van, for which no other insurance policy provides coverage, that: (1) Has a Gross Vehicle Weight of less than 12,500 lbs.; and (2) Is not used for the delivery or transportation of goods and materials unless such use is: Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 1 of 22

23 A-10-NH (08-13) (a) Incidental to your "business" of installing, maintaining, or repairing furnishings or equipment; or (b) For farming or ranching. 2. Coverage for a "newly acquired auto" is provided as described below if: a. You acquire the auto during the policy period; b. You ask us to insure a "newly acquired auto" within 30 days after you become the owner; and c. The "newly acquired auto" replaces one shown in the Declarations, it will have the same coverage as the vehicle it replaced. You must ask us to insure a replacement vehicle within 30 days only if you wish to add or continue Coverage for Damage to Your Auto. If the "newly acquired auto" is in addition to any shown in the Declarations, it will have the broadest coverage we now provide for any vehicle shown in the Declarations. L. "Minimum limits" Throughout the policy, "minimum limits" refers to the following limits of liability as required by New Hampshire law, to be provided under a policy of automobile liability insurance: 1. $25,000 for each person, subject to $50,000 for each accident, with respect to "bodily injury"; and 2. $25,000 for each accident with respect to "property damage". 3. $75,000 for each accident written on a Combined Single Limits Basis. PART A - LIABILITY COVERAGE INSURING AGREEMENT A. We will pay damages for "bodily injury" or "property damage" for which any "insured" becomes legally responsible because of an auto accident. We will settle or defend, as we consider appropriate, any claim or suit asking for these damages. In addition to our limit of liability, we will pay all defense costs we incur. Our duty to settle or defend ends when our limit of liability for this coverage has been exhausted by payment of judgments or settlements. We have no duty to defend any suit or settle any claim for "bodily injury" or "property damage" not covered under this policy. B. "Insured" as used in this Part means: 1. You or any "family member" for the ownership, maintenance, or use of any auto or "trailer". 2. Any person using "your covered auto" with your permission provided that the actual operation or use is within the scope of such permission. 3. For "your covered auto", any person or organization but only with respect to legal responsibility for acts or omissions of a person for whom coverage is afforded under this Part. 4. For any auto or "trailer", other than "your covered auto", any other person or organization but only with respect to legal responsibility for acts or omissions of you or any "family member" for whom coverage is afforded under this Part. This provision (B.4.) applies only if the person or organization does not own or hire the auto or "trailer". 5. Your chauffeur or domestic servant using any motor vehicle, trailer or semitrailer, other than "your covered auto", while engaged in your employment. This provision applies only if: a. The accident occurs in New Hampshire; and b. There is no other valid and collectible insurance applicable to the accident and available to your chauffeur or domestic servant. SUPPLEMENTARY PAYMENTS We will pay on behalf of an "insured": 1. Up to $250 for the cost of bail bonds required because of an accident, including related traffic law violations. The accident must result in "bodily injury" or "property damage" covered under this policy. 2. Premiums on appeal bonds and bonds to release attachments in any suit we defend. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 2 of 22

24 A-10-NH (08-13) 3. Interest accruing after a judgment is entered in any suit we defend. Our duty to pay interest ends when we offer to pay that part of the judgment which does not exceed our limit of liability for this coverage. 4. Up to $200 a day for loss of earnings, but not other income, because of attendance at hearings or trials at our request. 5. Other reasonable expenses incurred at our request. 6. Prejudgment interest awarded against the "insured" on that part of the judgment we pay. If we make an offer to pay our limit of liability, we will not pay any prejudgment interest based on that period of time after the offer. These payments will not reduce the limit of liability. EXCLUSIONS A. We do not provide Liability Coverage for any "insured": 1. For "bodily injury" or "property damage": a. Caused intentionally by or at the direction of an "insured"; or b. Resulting from any accident caused by an act of an "insured" with the intent to cause damage or injury of any nature. 2. For "property damage" to property owned or being transported by any "insured". 3. For "property damage" to property: a. Rented or leased to; b. Used by; or c. In the care of; any "insured". This Exclusion (A.3.) does not apply to "property damage" to a residence or private garage. 4. For "bodily injury" to an employee of that "insured" during the course of employment. This Exclusion (A.4.) does not apply to "bodily injury" to a domestic employee unless workers' compensation benefits are required or available for that domestic employee. 5. For that "insured's" liability arising out of the ownership or operation of a vehicle while it is being used as a public or livery conveyance. This Exclusion (A.5.) does not apply to a share-the-expense car pool. 6. While employed or otherwise engaged in the "business" of: a. Selling; b. Repairing; c. Servicing; d. Storing; or e. Parking; vehicles designed for use mainly on public highways. This includes road testing and delivery. This Exclusion (A.6.) does not apply to the ownership, maintenance, or use of "your covered auto" by: a. You; b. Any "family member"; or c. Any partner, agent, or employee of you or any "family member". 7. Maintaining or using any vehicle while that "insured" is employed or otherwise engaged in any "business" (other than farming or ranching) not described in Exclusion A.6. This Exclusion (A.7.) does not apply to the maintenance or use of a: a. Private passenger auto; b. Pickup or van that: (1) You own; or (2) You do not own while used as a temporary substitute for "your covered auto" which is out of normal use because of its: (a) Breakdown; (b) Repair; (c) Servicing; (d) Loss; or (e) Destruction; or c. "Trailer" used with a vehicle described in a. or b. above. 8. Using a vehicle without a reasonable belief that that "insured" is entitled to do so. This Exclusion (A.8.) does not apply to a "family member" using "your covered auto" which is owned by you. 9. For "bodily injury" or "property damage" for which that "insured": a. Is an insured under a nuclear energy liability policy; or b. Would be an insured under a nuclear energy liability policy, but for its termination upon exhaustion of its limit of liability. A nuclear energy liability policy is a policy issued by any of the following or their successors: Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 3 of 22

25 A-10-NH (08-13) a. Nuclear Energy Liability Insurance Association; b. Mutual Atomic Energy Liability Underwriters; or c. Nuclear Insurance Association of Canada. 10. Arising out of: a. Any punitive or exemplary damages, fines, costs, interest, or penalties; or b. Any attorney fees as a result of punitive or exemplary damages, fines, costs, interest, or penalties. 11. For which the United States Postal Service, The United States of America, or any of its agencies may be held liable arising from the operation of "your covered auto" by that "insured" as an employee of the United States government under the Federal Tort Claims Act, including any amendments. 12. For "bodily injury" or "property damage" caused by "your covered auto" when it is driven, operated, or used with your permission by a person other than a "family member" whom you know: a. Is under the minimum age to obtain a driver s license; b. Does not have a valid driver s license; or c. Has a restricted driver s license and is operating a vehicle beyond the scope of such restriction. This Exclusion (A.12.) does not apply when it is not required for a person to obtain a driver s license to operate "your covered auto". 13. For an "insured's" liability arising out of the operation of any vehicle: a. By that "insured"; and b. While that "insured's" driver's license is under suspension or revocation; to the extent that the limits of liability for this coverage exceed the minimum limits of liability required by the financial responsibility law of New Hampshire. However, this exclusion does not apply if the suspension or revocation can be directly attributed to our failure to file the necessary certification material with the director of the Division of Motor Vehicles. B. We do not provide Liability Coverage for the ownership, maintenance, or use of: 1. Any vehicle which: a. Has fewer than four wheels; or b. Is designed mainly for use off public roads. This Exclusion (B.1.) does not apply: a. While such vehicle is being used by an "insured" in a medical emergency; b. To any trailer; c. To any non-owned golf cart; or d. If there is no other valid and collectible insurance available to the "insured" for a non owned vehicle which: (1) Has fewer than four wheels: or (2) Is designed mainly for use off public roads. 2. Any vehicle, other than "your covered auto", which is: a. Owned by you; or b. Furnished for your regular use. 3. Any vehicle, other than "your covered auto", which is: a. Owned by any "family member"; or b. Furnished for the regular use of any "family member". However, this Exclusion (B.3.) does not apply to you while you are maintaining or "occupying" any vehicle which is: a. Owned by a "family member"; or b. Furnished for the regular use of a "family member". 4. Any vehicle while: a. Competing in; or b. Practicing or preparing for; any prearranged or organized racing, pulling, or speed contest; or any driving activity conducted on a permanent or temporary racetrack or racecourse. LIMIT OF LIABILITY A. The limit of liability shown in the Declarations for this coverage is our maximum limit of liability for all damages resulting from any one auto accident. B. The limit of liability shown in the Declarations for each person for Bodily Injury Liability is our maximum limit of liability for all damages, including damages for death and damages for all derivative claims including, but not limited to, claims for loss of services, loss of consortium, Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 4 of 22

26 A-10-NH (08-13) and claims for medical bills, incurred by any other person, arising out of "bodily injury" sustained by any one person in any one auto accident. Subject to this limit for each person, the limit of liability shown in the Declarations for each auto accident for Bodily Injury Liability is our maximum limit of liability for all damages for "bodily injury" resulting from any one auto accident. The limit of liability shown in the Declarations for each accident for Property Damage Liability is our maximum limit of liability for all "property damage" resulting from any one auto accident. C. With regards to A. or B. above, this is the most we will pay regardless of the number of: 1. "Insureds"; 2. Claims made; 3. Vehicles or premiums shown in the Declarations; or 4. Vehicles involved in the auto accident. D. We will apply the limit of liability to provide any separate limits required by law for bodily injury and property damage liability. However, this provision (D.) will not change our total limit of liability. E. No one will be entitled to receive duplicate payments for the same elements of loss under this coverage and Part C of this policy. OUT OF STATE COVERAGE If an auto accident to which this policy applies occurs in any state or province other than the one in which "your covered auto" is principally garaged, we will interpret your policy for that accident as follows: A. If the state or province has: 1. A financial responsibility or similar law specifying limits of liability for "bodily injury" or "property damage" higher than the limit shown in the Declarations, your policy will provide the higher specified limit. 2. A compulsory insurance or similar law requiring a nonresident to maintain insurance whenever the nonresident uses a vehicle in that state or province, your policy will provide at least the required minimum amounts and types of coverage. B. No one will be entitled to duplicate payments for the same elements of loss. FINANCIAL RESPONSIBILITY When this policy is certified as future proof of financial responsibility, this policy shall comply with the law to the extent required. OTHER INSURANCE If there is other applicable liability insurance we will pay only our share of the loss. Our share is the proportion that our limit of liability bears to the total of all applicable limits. However, any insurance we provide for a vehicle you do not own, including any vehicle while used as a temporary substitute for "your covered auto", shall be excess over any other collectible insurance. Any insurance we provide for use of a "your covered auto" by any person other than you or a family member will be excess over any other collectible insurance, self-insurance, or bond stated to be primary, contributing, excess or contingent. If this policy and any other auto insurance policy issued to you or any "family member" by us, or a member Company of the Ohio Mutual Insurance Group, apply to the same accident, the maximum limit of our liability under all policies shall not exceed the highest applicable limit of liability under any one policy. PART B - MEDICAL PAYMENTS COVERAGE INSURING AGREEMENT A. We will pay "reasonable" expenses incurred for "necessary" medical and funeral services because of "bodily injury": 1. Caused by an accident; and 2. Sustained by an "insured". We will pay only those expenses incurred for services rendered within one year from the date of the accident. B. "Insured" as used in this Part means: 1. You or any "family member": a. While "occupying"; or b. As a pedestrian when struck by; a motor vehicle designed for use mainly on public roads or a trailer of any type. 2. Any other person while "occupying" "your covered auto". Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 5 of 22

27 A-10-NH (08-13) C. "Reasonable" as used in this Part means: Expenses that are consistent with the usual and customary charges of the majority of similar medical providers in the geographic area in which the expenses were incurred for the specific medical service. D. "Necessary" as used in this Part means: Services that are rendered by a medical provider within the legally authorized scope of the provider s practice and are recognized within that practice as being appropriate treatment in achieving maximum medical improvement for the "bodily injury" sustained in the accident. EXCLUSIONS We do not provide Medical Payments Coverage for any "insured" for "bodily injury": 1. Sustained while "occupying" any motorized vehicle having fewer than four wheels. However, this Exclusion (1.) does not apply to "bodily injury" sustained while "occupying" a motorcycle. 2. Sustained while "occupying" "your covered auto" when it is being used as a public or livery conveyance. This Exclusion (2.) does not apply to a share-the-expense car pool. 3. Sustained while "occupying" any vehicle located for use as a residence or premises. 4. Occurring during the course of employment if workers' compensation benefits are required or available for the "bodily injury". 5. Sustained while "occupying", or when struck by, any vehicle (other than "your covered auto") which is: a. Owned by you; or b. Furnished for your regular use. 6. Sustained while "occupying", or when struck by, any vehicle (other than "your covered auto") which is: a. Owned by any "family member"; or b. Furnished for the regular use of any "family member". However, this Exclusion (6.) does not apply to you. 7. Sustained while "occupying" a vehicle without a reasonable belief that that "insured" is entitled to do so. This Exclusion (7.) does not apply to a "family member" using "your covered auto" which is owned by you. 8. Sustained while "occupying" a vehicle when it is being used in the "business" of an "insured". This Exclusion (8.) does not apply to "bodily injury" sustained while "occupying" a: a. Private passenger auto; b. Pickup or van; or c. "Trailer" used with a vehicle described in a. or b. above. 9. Caused by or as a consequence of: a. Discharge of a nuclear weapon (even if accidental); b. War (declared or undeclared); c. Civil war; d. Insurrection; or e. Rebellion or revolution. 10. From or as a consequence of the following, whether controlled or uncontrolled or however caused: a. Nuclear reaction; b. Radiation; or c. Radioactive contamination. 11. Sustained while "occupying" any vehicle while: a. Competing in; or b. Practicing or preparing for; any prearranged or organized racing, pulling, or speed contest; or any driving activity conducted on a permanent or temporary racetrack or racecourse. 12. Sustained: a. While that "insured" is operating any vehicle; and b. While that "insured's" driver's license is under suspension or revocation. However, this exclusion does not apply if the suspension or revocation can be directly attributed to our failure to file the necessary certification material with the director of the Division of Motor Vehicles. LIMIT OF LIABILITY A. The limit of liability shown in the Declarations for this coverage is our maximum limit of liability for each person injured in any one accident. This is the most we will pay regardless of the number of: 1. "Insureds"; 2. Claims made; 3. Vehicles or premiums shown in the Declarations; Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 6 of 22

28 A-10-NH (08-13) 4. Vehicles involved in the accident; or 5. Policies issued by us, or a member Company of the Ohio Mutual Insurance Group, to you or any "family member". B. We will pay under Part B - Medical Payments Coverage, the lesser of: 1. "Reasonable" expenses incurred by the "insured" for "necessary" medical and funeral services because of "bodily injury"; or 2. Any negotiated reduced rate accepted by a medical provider. C. We do not owe payment to the "insured" for any balance bill received by the "insured" if the medical provider has agreed to reduce the charge for services after a review by us. D. No one will be entitled to receive duplicate payments for the same elements of loss under this coverage and a health insurance policy. Payment Of Benefits Benefits payable under this coverage shall not be assignable to any health care provider. OTHER INSURANCE If there is other applicable auto medical payments insurance we will pay only our share of the loss. Our share is the proportion that our limit of liability bears to the total of all applicable limits. However, any insurance we provide with respect to a vehicle you do not own, including any vehicle while used as a temporary substitute for "your covered auto", shall be excess over any other collectible auto insurance providing payments for medical or funeral expenses. PART C - UNINSURED MOTORISTS AND UNDERINSURED MOTORISTS COVERAGE INSURING AGREEMENT A. We will pay compensatory damages which an "insured" is legally entitled to recover from the owner or operator of: 1. An "uninsured motor vehicle" or "underinsured motor vehicle" because of "bodily injury" sustained by an "insured" and caused by an accident; and 2. An "uninsured motor vehicle" only as defined in D.5. of this Part because of "property damage" caused by an accident. The owner's or operator's liability for these damages must arise out of the ownership, maintenance or use of the "uninsured motor vehicle" or "underinsured motor vehicle". With respect to damages an "insured" is legally entitled to recover from the owner or operator of an "underinsured motor vehicle", we will pay under this coverage only if 1. or 2. below applies: 1. The limits of liability under any bodily injury liability bonds or policies applicable to the "underinsured motor vehicle" have been exhausted by payment of judgments or settlements; or 2. A tentative settlement has been made between an "insured" and the insurer of the "underinsured motor vehicle" and we: a. Have been given prompt written notice of such tentative settlement; and b. Advance payment to the "insured" in an amount equal to the tentative settlement within 30 days after receipt of notification. Any judgment for damages arising out of a suit brought without our written consent is not binding on us. B. "Insured" as used in this Part C. means: 1. You or any "family member"; 2. Any other person "occupying" "your covered auto", if that person is not insured for Uninsured Motorists and Underinsured Motorists Coverage under another policy; or 3. Any person for damages that person is entitled to recover because of "bodily injury" to which this coverage applies sustained by a person described in 1. or 2. above. C. "Property damage" as used in this Part C. means injury to or destruction of: 1. "Your covered auto". 2. Any property owned by a person listed in 1. or 2. of "insured" while contained in "your covered auto". D. "Uninsured motor vehicle" means a land motor vehicle or trailer of any type: 1. To which no bodily injury liability bond or policy applies at the time of the accident. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 7 of 22

29 A-10-NH (08-13) 2. To which a bodily injury liability bond or policy applies at the time of the accident. In this case, its limit for bodily injury liability must be less than the minimum limit for bodily injury liability specified by the financial responsibility law of New Hampshire. 3. Which is a hit-and-run vehicle whose operator or owner cannot be identified and which hits or which causes an accident resulting in "bodily injury" without hitting: a. You or any "family member"; b. A vehicle which you or any "family member" are "occupying"; or c. "Your covered auto". If there is no physical contact with the hitand-run vehicle, the facts of the accident must be proved. We will only accept competent evidence other than the testimony of a person making a claim under this or any similar coverage. 4. To which a bodily injury liability bond or policy applies at the time of the accident but the bonding or insuring company: a. Denies coverage; or b. Is or becomes insolvent. 5. To which a liability bond or policy applies at the time of the accident but the bonding or insuring company is or becomes insolvent within three years of the date of the accident and the loss is property damage under INSURING AGREEMENT A.2. E. "Underinsured motor vehicle" means a land motor vehicle or trailer of any type to which a bodily injury liability bond or policy applies at the time of the accident in limits equal to or greater than the minimum limits specified by the financial responsibility law of New Hampshire but less than the limit of liability for this coverage. However, "underinsured motor vehicle" does not include any vehicle or equipment to which a bodily injury liability bond or policy applies at the time of the accident but the bonding or insuring company: 1. Denies coverage; or 2. Is or becomes insolvent. In addition, neither "uninsured motor vehicle" nor "underinsured motor vehicle" includes any vehicle or equipment: 1. Owned by or furnished for the regular use of you or any "family member". 2. Owned or operated by a self-insurer under any applicable motor vehicle law, except a self-insurer which is or becomes insolvent. 3. Owned by any governmental unit or agency. 4. Operated on rails or crawler treads. 5. Designed mainly for use off public roads while not on public roads. 6. While located for use as a residence or premises. EXCLUSIONS A. We do not provide Uninsured Motorists and Underinsured Motorists Coverage for "property damage" or "bodily injury" sustained: 1. By an "insured" while "occupying", or when struck by, any motor vehicle owned by that "insured" which is not insured for this coverage under this policy. This includes a trailer of any type used with that vehicle. 2. By any "family member" while "occupying", or when struck by, any motor vehicle you own which is insured for this coverage on a primary basis under any other policy. 3. By an "insured": a. While that "insured" is operating any vehicle; and b. While that "insured's" driver's license is under suspension or revocation. However, this Exclusion (A.3.) does not apply if the suspension or revocation can be directly attributed to our failure to file the necessary certification material with the director of the division of motor vehicles. B. We do not provide Uninsured Motorists and Underinsured Motorists Coverage for "property damage" or "bodily injury" sustained by any "insured": 1. If that "insured" or the legal representative settles the "bodily injury" or "property damage" claim and such settlement prejudices our right to recover payment. However, this Exclusion (B.1.) does not apply to damages an "insured" is legally entitled to recover from the owner or operator of an "underinsured motor vehicle". 2. While "occupying" "your covered auto" when it is being used as a public or livery conveyance. This Exclusion (B.2.) does not apply to a share-the-expense car pool. 3. Using a vehicle without a reasonable belief that that "insured" is entitled to do so. This Exclusion (B.3.) does not apply to a "family Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 8 of 22

30 A-10-NH (08-13) member" using "your covered auto" which is owned by you. C. This coverage shall not apply directly or indirectly to benefit: 1. Any insurer or self-insurer under any of the following or similar law: a. Workers' compensation law; or b. Disability benefits law. 2. Any insurer of property. D. We do not provide Uninsured Motorists and Underinsured Motorists Coverage for: 1. Punitive or exemplary damages. 2. Any attorney fees as a result of punitive or exemplary damages, fines, costs, interest, or penalties. LIMIT OF LIABILITY A. The limit of liability shown in the Declarations for this coverage is our maximum limit of liability for all damages resulting from any one auto accident. B. The limit of liability shown in the Declarations for each person for Uninsured Motorists and Underinsured Motorists Coverage is our maximum limit of liability for all damages, including damages for death and damages for all claims including, but not limited to, claims for loss of services, loss of consortium, and claims for medical bills arising out of "bodily injury" sustained by any one person in any one auto accident. Subject to this limit for each person, the limit of liability shown in the Declarations for each auto accident for Uninsured Motorists and Underinsured Motorists Coverage is our maximum limit of liability for all damages for "bodily injury" resulting from any one auto accident. C. The limit of liability with respect to property damage covered under insuring agreement A.2. is $25,000 each accident. D. With regards to A., B., or C. above, this is the most we will pay regardless of the number of: 1. "Insureds"; 2. Claims made; 3. Vehicles or premiums shown in the Declarations; or 4. Vehicles involved in the accident. E. With respect to damages caused by an accident with an "underinsured motor vehicle": 1. The limit of liability shall be reduced by all sums paid because of the "bodily injury" by or on behalf of persons or organizations who may be legally responsible. This includes all sums paid under Part A of this policy. 2. We will not pay for any element of loss if a person is entitled to receive payment for the same element of loss under any of the following or similar law: a. Workers' compensation law; or b. Disability benefits law. F. The limit of liability for this coverage applies separately to damages caused by an accident with an "uninsured motor vehicle" or "underinsured motor vehicle". G. Any amount payable for "property damage" under this coverage will not reduce any amount payable to an "insured" under this coverage for "bodily injury". H. No payment will be made for loss paid or payable to the "insured" under Part D of this policy. I. No one will be entitled to receive duplicate payments for the same elements of loss under this coverage and Part A of this policy. J. We will not make a duplicate payment under this coverage for any element of loss for which payment has been made by or on behalf of persons or organizations who may be legally responsible. ACTION AGAINST THE COMPANY A. No suit or any proceeding in arbitration shall be brought against the company for the recovery of any claim resulting from the owner or operator of an "uninsured motor vehicle" or "underinsured motor vehicle" unless as a condition precedent thereto, the "insured" or his legal representative has fully complied with all terms of the policy and unless the suit or proceeding in arbitration is commenced against the company in compliance with B.1. and B.2. shown below: B. We will pay as long as: 1. The "insured" has not prejudiced our subrogation rights; and 2. Each claim or suit for Uninsured Motorists and Underinsured Motorists Coverage has been made or brought within three years the time period permitted by law after the date of accident causing "property damage", "bodily injury", sickness, disease, or death, or within one year after the liability insurer for the owner or operator of the motor vehicle liable to the "insured" has become the subject of insolvency proceedings in any state, whichever is later. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 9 of 22

31 A-10-NH (08-13) OTHER INSURANCE A. If there is other applicable insurance available under one or more policies or provisions of coverage that is similar to the insurance provided under this Part of the policy: 1. Any recovery for damages under all such policies or provisions of coverage may equal but not exceed the highest applicable limit for any one vehicle under any insurance providing coverage on either a primary or excess basis. 2. Any insurance we provide with respect to a vehicle you do not own, including any vehicle while used as a temporary substitute for "your covered auto", shall be excess over any collectible insurance providing such coverage on a primary basis. 3. If the coverage under this policy is provided: a. On a primary basis, we will pay only our share of the loss that must be paid under insurance providing coverage on a primary basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage provided on a primary basis. b. On an excess basis, we will pay only our share of the loss that must be paid under insurance providing coverage on an excess basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage provided on an excess basis. B. With respect to "property damage", this insurance shall apply only after the limits of any other collectible insurance applicable to the damaged property have been exhausted. ARBITRATION A. If we and an "insured" do not agree: 1. Whether that "insured" is legally entitled to recover damages; or 2. As to the amount of damages which are recoverable by that "insured"; from the owner or operator of an "uninsured motor vehicle" or "underinsured motor vehicle", then the matter may be arbitrated. However, disputes concerning coverage under this Part may not be arbitrated. Both parties must agree to arbitration. If the "insured" and company do not agree to arbitrate, then the "insured" or company may bring suit to determine the right to recovery and as to the amount of damage, under this agreement, as in other civil cases If so agreed, each party will select an arbitrator. The two arbitrators will select a third. If they cannot agree on the third arbitrator within 30 days, either may request that selection be made by a judge of a court having jurisdiction. B. Each party will: 1. Pay the expenses it incurs; and 2. Bear the expenses of the third arbitrator equally. 3. However, the "insured" will not be required to advance the expenses of arbitration. C. Unless both parties agree otherwise, arbitration will take place in the county in which the "insured" lives. Local rules of law as to procedure and evidence will apply. A decision agreed to by two of the arbitrators will be binding as to: 1. Whether the "insured" is legally entitled to recover damages; and 2. The amount of damages. ADDITIONAL DUTY AFTER AN ACCIDENT OR LOSS A person seeking Underinsured Motorists Coverage must also promptly: A. Send us copies of the legal papers if a suit is brought; and B. Notify us in writing of a tentative settlement between the "insured" and the insurer of the "underinsured motor vehicle", and allow us 30 days to advance payment to that "insured" in an amount equal to the tentative settlement to preserve our rights against the insurer, owner, or operator of such "underinsured motor vehicle". However, this Paragraph (B.) does not apply if failure to notify us does not prejudice our rights against the insurer, owner, or operator of such "underinsured motor vehicle". Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 10 of 22

32 A-10-NH (08-13) PART D - COVERAGE FOR DAMAGE TO YOUR AUTO INSURING AGREEMENT A. We will pay for direct and accidental loss to "your covered auto" or any "non-owned auto", including their equipment not otherwise excluded, minus any applicable deductible shown in the Declarations. If loss to more than one "your covered auto" or "non-owned auto" results from the same "collision", only the highest applicable deductible will apply. However, we will not apply a deductible if the damage to "your covered auto" or any "non-owned auto" is caused by "collision" with an "uninsured motor vehicle" and the operator of the "uninsured motor vehicle": 1. Is solely at fault; and 2. Has been positively identified. We will pay for the loss to "your covered auto" caused by: 1. Other than "collision" only if the Declarations indicate that Other Than Collision Coverage is provided for that auto. 2. "Collision" only if the Declarations indicate that Collision Coverage is provided for that auto. If there is a loss to a "non-owned auto", we will provide the broadest coverage applicable to any "your covered auto" shown in the Declarations. B. "Collision" means the upset of "your covered auto" or a "non-owned auto" or their impact with another vehicle or object. Loss caused by the following is considered other than "collision": 1. Missiles or falling objects; 2. Fire; 3. Theft or larceny; 4. Explosion or earthquake; 5. Windstorm; 6. Hail, water, or flood; 7. Malicious mischief or vandalism; 8. Riot or civil commotion; 9. Contact with bird or animal; or 10. Breakage of glass. However, coverage for other than "collision" losses is not restricted to the above listed causes of loss. If breakage of glass is caused by a "collision", you may elect to have it considered a loss caused by "collision". C. "Non-owned auto" means: 1. Any private passenger auto, pickup, van or "trailer", including any such vehicle rented to you or any "family member", not owned by or furnished for the regular use of you or any "family member" while in the custody of or being operated by you or any "family member"; or 2. Any auto or "trailer" you do not own while used as a temporary substitute for "your covered auto" which is out of normal use because of its: a. Breakdown; b. Repair; c. Servicing; d. Loss; or e. Destruction. D. "Custom furnishings or equipment" means equipment, devices, accessories, enhancements, and changes other than those that are offered by the manufacturer specifically for that auto model, or installed by the auto dealership when new as part of the original sale which are permanently installed or attached and alter the appearance or performance of the auto. This includes but it not limited to: 1. Body, engine, exhaust, or suspension enhancers; 2. Winches, anti-roll, or anti-sway bars; 3. Custom grilles, louvers, side pipes, hood scoops, or spoilers; 4. Custom wheels, tires, or spinners; or 5. Custom chrome, paintwork, decals, or graphics. TRANSPORTATION EXPENSES A. In addition, we will pay, without application of a deductible, up to a maximum of $600 for: 1. Temporary transportation expenses not exceeding $20 per day incurred by you in the event of a loss to "your covered auto". We will pay for such expenses if the loss is caused by: Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 11 of 22

33 A-10-NH (08-13) a. Other than "collision" only if the Declarations indicate that Other Than Collision Coverage is provided for that auto. b. "Collision" only if the Declarations indicate that Collision Coverage is provided for that auto. 2. Expenses for which you become legally responsible in the event of loss to a "nonowned auto". We will pay for such expenses if the loss is caused by: a. Other than "collision" only if the Declarations indicate that Other Than Collision Coverage is provided for any "your covered auto". b. "Collision" only if the Declarations indicate that Collision Coverage is provided for any "your covered auto". However, the most we will pay for any expenses for loss of use is $20 per day. B. Subject to the provisions of Paragraph A., if the loss is caused by: 1. A total theft of "your covered auto" or a "nonowned auto", we will pay only expenses incurred during the period: a. Beginning 48 hours after the theft; and b. Ending when "your covered auto" or the "non-owned auto" is returned to use or we pay for its loss. 2. Other than theft of a "your covered auto" or a "non-owned auto", we will pay only expenses beginning when the auto is withdrawn from use for more than 24 hours. Our payment will be limited to that period of time reasonably required to repair or replace the "your covered auto" or the "non-owned auto". CAMPING VEHICLES - AWNING A. We will pay for direct and accidental loss to: 1. Facilities or equipment designed to be used with the camping vehicle while in or attached to the camping vehicle shown in the Declarations, for which a specific premium charge indicates that Camping Vehicles - Awning Coverage is provided. Facilities or equipment include, but are not limited to: a. Cooking, dining, plumbing, or refrigeration facilities; b. Awnings or cabanas; c. Radio and television antennas; or d. Any other facilities or equipment designed to be used with a camping vehicle. We will pay for loss caused by: 1. Other than "collision" only if the Declarations indicate that Other Than Collision Coverage is provided for that camping vehicle. 2. "Collision" only if the Declarations indicate that Collision Coverage is provided for that camping vehicle. B. The following Exclusions are added: 1. We will not pay for loss to: a. Clothing or luggage; b. "Business" or office equipment; or c. Articles, carried or held as samples, for sale, storage, repair, or used in exhibitions. d. Skirting 2. This coverage does not apply to furnishings or equipment that are excluded from coverage under Exclusions 4., 5., or 10. of Part D. C. Our limit of liability for loss will be the lesser of the: 1. Amount shown in the Declarations; 2. Actual cash value of the stolen or damaged property; or 3. Amount necessary to repair or replace the property with other property of like kind and quality. Our payment for loss will be reduced by any applicable deductible shown in the Declarations. If loss to more than one "your covered auto" results from the same "collision", only the highest applicable deductible will apply. An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total loss. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. CAMPING VEHICLES - CONTENTS We will pay for direct and accidental loss to "covered property" while it is in, upon, or used within 50 feet of the camping vehicle shown in the Declarations for which a specific premium charge indicates that Camping Vehicles - Contents Coverage is provided. "Covered property" means furniture or other personal property belonging to you, or if you so elect, belonging to a "family member". We will not pay for loss to: Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 12 of 22

34 A-10-NH (08-13) 1. Equipment or accessories which are part of the camping vehicle or "your covered auto". 2. Articles, carried or held as samples, for sale, storage, repair, or used in exhibitions. 3. "Business" or office equipment. 4. Records or accounts, currency, coins, stamps, or any other form of money. Our limit of liability for loss will be the lesser of the following: 1. Amount shown in the Declarations; 2. Actual cash value of the property; or 3. Amount necessary to repair or replace the property. In order for theft coverage to apply, there must be visible signs of forcible entry into the camping vehicle, and a police report must be promptly filed. Our payment for loss will be reduced by any applicable deductible shown in the Declarations. If loss to more than one "your covered auto" results from the same "collision", only the highest applicable deductible will apply. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. PERSONAL EFFECTS In addition, we will pay up to a maximum of $250 for loss of personal effects in "your covered auto". This coverage applies in the event of loss by: 1. Fire; 2. Lightning; or 3. Total theft of "your covered auto". EXCLUSIONS We will not pay for: 1. Loss to "your covered auto" or any "nonowned auto" which occurs while it is being used as a public or livery conveyance. This Exclusion (1.) does not apply to a share-theexpense car pool. 2. Damage due and confined to: a. Wear and tear; b. Freezing; c. Mechanical or electrical breakdown or failure; or d. Road damage to tires. No coverage is provided for consequential damage or loss to any type of property which results from Wear and Tear, Freezing, and Mechanical or Electrical Breakdown or failure including, but not limited to: a. Water damage, including seepage; and b. Rust or corrosion. This Exclusion (2.) does not apply if the damage results from the total theft of "your covered auto" or any "non-owned auto". 3. Loss due to or as a consequence of: a. Radioactive contamination; b. Discharge of any nuclear weapon (even if accidental); c. War (declared or undeclared); d. Civil war; e. Insurrection; or f. Rebellion or revolution. 4. Loss to any electronic equipment that reproduces, receives or transmits audio, visual or data signals. This includes but is not limited to: a. Radios and stereos; b. Tape decks; c. Compact disk systems; d. Navigation systems; e. Internet access systems; f. Personal computers; g. Video entertainment systems; h. Telephones; i. Televisions; j. Two-way mobile radios; k. Scanners; or l. Citizens band radios. This Exclusion (4.) does not apply to electronic equipment that is permanently installed in "your covered auto" or any "nonowned auto". 5. Loss to tapes, records, disks, or other media used with equipment described in Exclusion Loss to "your covered auto" or any "nonowned auto": a. While it is being used on a temporary or permanent basis, for the transportation of, or in exchange for, any illegal substance, or in connection with any criminal trade or transaction by: (1) You; (2) Any "family member"; or (3) Any other person with your knowledge or permission; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 13 of 22

35 A-10-NH (08-13) b. Due to destruction or confiscation by governmental or civil authorities because of its use in such activities. 7. Loss to a camper body or "trailer" you own which is not shown in the Declarations. This Exclusion (7.) does not apply to a camper body or "trailer" you: a. Acquire during the policy period; and b. Ask us to insure within 30 days after you become the owner. 8. Loss to any "non-owned auto" when used by you or any "family member" without a reasonable belief that you or that "family member" are entitled to do so. 9. Loss to: a. Radios and television antennas; b. Awnings or cabanas; or c. Any other facilities or equipment designed to be used with a camping vehicle. This Exclusion (9.) does not apply to coverage provided under Camping Vehicles - Awning Coverage except for losses in excess of the amount shown in the Declarations under Camping Vehicles - Awning Coverage. 10. Loss to equipment designed or used for the detection or location of radar or laser. 11. Loss to any "non-owned auto" being maintained or used by any person while employed or otherwise engaged in the "business" of: a. Selling; b. Repairing; c. Servicing; d. Storing; or e. Parking; vehicles designed for use on public highways. This includes road testing and delivery. 12. Loss to any "non-owned auto" being maintained or used by any person while employed or otherwise engaged in any "business" not described in Exclusion 11. This Exclusion (12.) does not apply to the maintenance or use by you or any "family member" of a "non-owned auto" which is a private passenger auto or "trailer. 13. Loss to "your covered auto" or any "nonowned auto" while: a. Competing in; or b. Practicing or preparing for; any prearranged or organized racing, pulling, or speed contest; or any driving activity conducted on a permanent or temporary racetrack or racecourse. 14. Loss to, or loss of use of, a "non-owned auto" rented by: a. You; or b. Any "family member"; if a rental vehicle company is precluded from recovering such loss or loss of use, from you or that "family member", pursuant to the provisions of any applicable rental agreement or state law. 15. Loss to "your covered auto" or any "nonowned auto" due to "diminution in value" or "residual diminution in value". "Diminution in value" means the actual or perceived loss in market or resale value which results from a direct and accidental loss. Residual diminution in value means the difference between the actual or perceived market or resale value immediately before a direct and accidental loss and the actual or perceived market or resale value immediately after repairs have been completed. LIMIT OF LIABILITY A. Our limit of liability for loss will be the lesser of the: 1. Actual cash value of the stolen or damaged property; or 2. Amount necessary to repair or replace the property with other property of like kind and quality. However, the most we will pay for loss to: 1. Any "non-owned auto" which is a "trailer" is $1, Electronic equipment that reproduces, receives or transmits audio, visual or data signals, which is permanently installed in the auto in locations not used by the auto manufacturer specifically for that auto model for installation of such equipment is $1, "Custom furnishings or equipment" is $2,000 if the Declarations does not show Custom Vehicle -Yes- for "your covered auto" or any "non-owned auto". Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 14 of 22

36 A-10-NH (08-13) B. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of loss. C. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. D. If the damaged property was previously damaged but you did not have it repaired or replaced, we will reduce the amount payable for the loss by the amount of the previous damage. E. If you agree to repair instead of replace your damaged windshield, we will pay the full cost of repairing the windshield regardless of your deductible. F. We will not make a duplicate payment under this coverage for any element of loss for which payment has been made, including payments made by or on behalf of persons or organizations who may be legally responsible. PAYMENT OF LOSS We may pay for loss in money, or repair or replace the damaged or stolen property. We may, at our expense, return any stolen property to: 1. You; or 2. The address shown in this policy. If we return stolen property, we will pay for any damage resulting from the theft. We may keep all or part of the property at an agreed or appraised value. If we pay for loss in money, our payment will include the applicable sales tax for the damaged or stolen property. LOSS PAYABLE CLAUSE Loss or damage under this policy shall be paid, as interest may appear, to you and the loss payee shown in the Declarations. This insurance with respect to the interest of the loss payee, shall not become invalid because of your fraudulent acts or omissions unless the loss: 1. Results from conversion, secretion, embezzlement, or willful damaging or destruction, of "your covered auto" committed by or at the direction of an "insured". 2. To "your covered auto" occurs while it is being used on a temporary or permanent basis, for the transportation of, or in exchange for, any illegal substance, or in connection with any criminal trade or transaction. However, we reserve the right to cancel the policy as permitted by policy terms and the cancellation shall terminate this agreement as to the loss payee's interest. We will give the same advance notice of cancellation to the loss payee as we give to the named insured shown in the Declarations. When we pay the loss payee we shall, to the extent of payment, be subrogated to the loss payee's rights of recovery. NO BENEFIT TO BAILEE This insurance shall not directly or indirectly benefit any carrier or other bailee for hire. OTHER SOURCES OF RECOVERY If other sources of recovery also cover the loss, we will pay only our share of the loss. Our share is the proportion that our limit of liability bears to the total of all applicable limits. However, any insurance we provide with respect to a "non-owned auto" shall be excess over any other collectible source of recovery including, but not limited to: 1. Any coverage provided by the owner of the "non-owned auto"; 2. Any other applicable physical damage insurance; or 3. Any other source of recovery applicable to the loss. APPRAISAL A. If we and you do not agree on the amount of loss, either may demand an appraisal of the loss. In this event, each party will select a competent and impartial appraiser. The two appraisers will select an umpire. The appraisers will state separately the actual cash value and the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: 1. Pay its chosen appraiser; and 2. Bear the expenses of the appraisal and umpire equally. B. We do not waive any of our rights under this policy by agreeing to an appraisal. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 15 of 22

37 A-10-NH (08-13) PART E - OPTIONAL COVERAGES INSURING AGREEMENT The coverages shown in this section are available to you as options. Coverages described DO NOT APPLY unless shown in the Declarations and unless a premium charge is shown for them in the Declarations. ACCIDENTAL DEATH COVERAGE INSURING AGREEMENT A. We agree to pay for accidental death caused by an auto accident. The coverage applies only if you or a "family member" dies as a result of injuries sustained in an auto accident within 90 days of the date of the accident. B. Insured as used in this Part means you or any family member. EXCLUSIONS This coverage does not apply to: A. Bodily injury or death sustained by an insured in the course of their occupation while engaged in duties incident to the: 1. Operation, loading or unloading of, or as an assistant on, a public livery conveyance or commercial auto, or 2. Repair or servicing of autos. B. Suicide, sane or insane, or to any attempt thereat. C. Injury or death due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing. LIMIT OF LIABILITY: $5,000 for each accidental death of you or your spouse. $1,000 for each accidental death of a "family member". TWO OR MORE AUTO POLICIES If this policy and any other auto insurance policy issued to you or any family member by us, or a member Company of the Ohio Mutual Insurance Group, apply to the same accident for Accidental Death Coverage the maximum limit we will pay is $5,000 regardless of the number of policies. PAYMENT OF ACCIDENTAL DEATH COVERAGE If the decedent is survived by a spouse who was a resident of the same household at the time of the auto accident, Accidental Death Coverage is payable to such spouse; otherwise, if the decedent was a minor, Accidental Death Coverage is payable to any parent thereof who was a resident of the same household at the time of the auto accident; otherwise, Accidental Death Coverage is payable to the estate of the decedent. The following optional coverages are subject to the provisions and Exclusions that apply to Part D - Coverage For Damage To Your Auto, except as changed by optional coverage(s) purchased. BROAD FORM COLLISION COVERAGE We agree to waive the deductible shown under Collision Coverage subject to a maximum amount of $250 provided: A. "Your covered auto" is not occupied by any person and is legally parked; or B. The loss results from accidental "collision" with an "uninsured motor vehicle" as defined in Part C - Uninsured Motorists And Underinsured Motorists Coverage, and the deductible is not otherwise waived under Part D, Insuring Agreement A. BROAD FORM GLASS When there is a loss to "your covered auto" described in the Declarations for which a specific premium charge indicates that Broad Form Glass Coverage is afforded: The following is added to the first paragraph of the Insuring Agreement in Part D - Coverage For Damage To Your Auto: We will pay under Other Than Collision Coverage for the cost of replacing damaged safety glass on "your covered auto" without a deductible. DIFFERENCE IN VALUE COVERAGE FOR LOAN/LEASE AUTOS In the event of a covered total loss to a "your covered auto" shown in the Declarations for which a specific premium charge indicates that Difference In Value Coverage For Loan/Lease Autos applies, the Limit of Liability Provision in Part D - Coverage For Damage To Your Auto, with respect to that coverage is replaced by the following: A. Our limit of liability for loss will be the greater of the: 1. Amount due under the terms of the loan or lease to which "your covered auto" is subject, but not to include: a. Overdue loan/lease payments at the Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 16 of 22

38 A-10-NH (08-13) time of the loss; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear, unrepaired damage, or high mileage; c. Security deposits not refunded by a lessor; d. Cost for extended warranties; e. Credit Life Insurance, Health, Accident, or Disability insurance purchased with the loan or lease; and f. Carry-over balances from previous loans or leases; or 2. Actual cash value of the stolen or damaged property. B. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of loss. C. We will not make duplicate payment under this coverage for the same element of loss for which payment was made. For the purposes of this optional coverage, total loss means a loss in which the cost of repairs plus the salvage value exceeds the actual cash value. This coverage shall apply only to the original loan or lease written on "your covered auto" not previously titled. EXCESS ELECTRONIC EQUIPMENT COVERAGE NOTICE The amount shown in the Declarations is not necessarily the amount you will receive at the time of loss or damage for the described property. Refer to the Limit of Liability provisions below. A. Excess Electronic Equipment The following is added to Paragraph A. of the Limit of Liability provision in Part D - Coverage For Damage To Your Auto: In the event of a loss to a "non-owned auto", or to a "your covered auto" shown in the Declarations for which Excess Electronic Equipment Coverage applies: The most we will pay for loss to electronic equipment that reproduces, receives or transmits audio, visual or data signals that is permanently installed in the auto, in locations not used by the auto manufacturer for installation of such equipment is increased from $1,000 to the amount shown in the Declarations. B. Coverage For Tapes, Records, Disks, Or Other Media 1. Exclusion 5. of Part D - Coverage For Damage To Your Auto does not apply to the extent that coverage is provided for tapes, records, disks, or other media. 2. We will also pay, without application of a deductible, for direct and accidental loss to tapes, records, disks, or other media if they are: a. Owned by you or any "family member"; and b. In or upon "your covered auto" or any "non-owned auto" at the time of the loss. 3. With respect to Coverage For Tapes, Records, Disks, Or Other Media, the Limit of Liability provision in Part D - Coverage For Damage To Your Auto is replaced by the following: LIMIT OF LIABILITY 1. Our limit of liability for the total of all losses to tapes, records, disks, or other media, as a result of any one occurrence shall be the lesser of: a. $200; b. The actual cash value of the stolen or damaged property; or c. The amount necessary to repair or replace the property with other property of like kind and quality. If Excess Electronic Equipment Coverage is purchased, the limit of liability applicable for losses to tapes, records, disks, or other media is in addition to any limits of liability applicable to Excess Electronic Equipment Coverage. 2. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of loss. 3. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. OPTIONAL LIMITS TRANSPORTATION EXPENSES COVERAGE When there is a loss to a "your covered auto" described in the Declarations for which a specific premium charge indicates that Optional Limits Transportation Expenses Coverage is afforded, or to a "non-owned auto": Coverage for Transportation Expenses provided under Part D - Coverage For Damage To Your Auto of this policy is increased to the limits shown in the Declarations. REPAIR OR REPLACEMENT COVERAGE At our option, we will pay to repair or replace the auto to which this coverage applies as shown in the Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 17 of 22

39 A-10-NH (08-13) Declarations for a covered "collision" loss. This coverage does not automatically transfer to any replacement auto or additional auto acquired during the policy period. This coverage does not apply to any other vehicle including, but not limited to, additional autos, replacement autos, substitute autos, and/or any "non-owned auto". Part D - Coverage For Damage To Your Auto - Limit of Liability is deleted and replaced by the following: LIMIT OF LIABILITY We will pay to repair or replace the auto to which this coverage applies as shown in the Declarations for a covered "collision" loss subject to the applicable deductible and without deduction for depreciation. A. Our limit of liability for loss will be the lesser of the: 1. Reasonable cost of repair or replacement of parts using parts manufactured by or for the vehicle's manufacturer, if available, or other sources when necessary and as lawful; or 2. Cost of a new auto of the same make and model with the same equipment. If an auto of the same make and model with the same equipment is not available, the new auto must be of similar size, class, body type, and equipment. A new auto is an auto that has not been previously titled and is of the latest model year available at the time of loss. However, the most we will pay for loss to a "nonowned auto" which is a "trailer" is $1,500. B. If the damaged property was previously damaged but you did not have it repaired or replaced, we will reduce the amount payable for the loss by the amount of the previous damage. We reserve the right to repair or replace the damaged auto or to pay for the loss in money. We will not pay, under this optional coverage, for: A. An auto which is more than 24 months old from the date of purchase or has more than 24,000 miles on the odometer at the time of loss, whichever occurs first. B. Any auto that was not new when purchased. New means the auto was not previously titled and has less than 200 miles on the odometer on the date you became the owner. C. An accident involving a single vehicle or an accident involving another vehicle where the other driver is not identified. D. Any accident when a police report is not filed within 24 hours of that accident. E. Loss caused by other than "collision". F. We will not make duplicate payment under this coverage for the same element of loss for which payment was made. TAPES, RECORDS, DISKS, OR OTHER MEDIA ONLY COVERAGE We will pay, without the application of a deductible, for the direct and accidental loss to tapes, records, disks, or other media if they are: A. Owned by you or any "family member"; and B. In or upon "your covered auto" or any "non-owned auto" at the time of the loss. Our limit of liability for the total of all losses to tapes, records, disks, or other media, as a result of any one occurrence shall be the lesser of: A. $200; B. The actual cash value of the stolen or damaged property; or C. The amount necessary to repair or replace the property with other property of like kind and quality. If Tapes, Records, Disks, Or Other Media Only Coverage is purchased, the limit of liability applicable for losses to tapes, records, disks, or other media is in addition to the limit of liability applicable to Excess Electronic Equipment Coverage and any accessories used with either equipment. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of loss. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. TOWING AND LABOR COVERAGE We will pay towing and labor costs incurred each time "your covered auto" or any "non-owned auto" is disabled, up to the amount shown in the Declarations as applicable to that vehicle. If a "non-owned auto" is disabled, we will provide the broadest towing and labor costs coverage applicable to any "your covered auto" shown in the Declarations. We will only pay for labor performed at the place of disablement. TRIP INTERRUPTION COVERAGE INSURING AGREEMENT With respect to a "your covered auto" shown in the Declarations for which a specific premium charge indicates that Trip Interruption Coverage is afforded, we will pay, without application of a deductible, up to a maximum limit shown in the Declarations for reasonable: A. Transportation expenses incurred by you in the event of a mechanical or electrical breakdown of "your covered auto". Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 18 of 22

40 A-10-NH (08-13) B. Expenses incurred by you for lodging and meals in the event of: 1. Direct and accidental loss to "your covered auto" caused by "collision" or other than "collision"; or 2. Mechanical or electrical breakdown of "your covered auto". This coverage applies only if: A. The loss to, or mechanical or electrical breakdown of, "your covered auto" occurs more than 100 miles from home; and B. The "your covered auto" is withdrawn from use for at least 24 hours. LIMIT OF LIABILITY A. Our payment for Trip Interruption Coverage will be limited to that period of time reasonably required to: 1. Resume travel under a prearranged itinerary; or 2. Return home. B. No one will be entitled to receive duplicate payments for the same elements of loss under this coverage and Part D - Coverage For Damage To Your Auto of the policy. OTHER SOURCES OF RECOVERY Any insurance we provide with respect to Trip Interruption Coverage shall be excess over any other collectible source of recovery including, but not limited to: A. Any coverage provided by: 1. Vehicle warranties; 2. Automobile clubs; or 3. Mechanical breakdown or similar plans; or B. Any other source of recovery applicable to the loss. PART F - DUTIES AFTER AN ACCIDENT OR LOSS We have no duty to provide coverage under this policy if the failure to comply with the following duties is prejudicial to us: A. We must be notified promptly of how, when, and where the accident or loss happened. Notice should also include the names and addresses of any injured persons and of any witnesses. B. A person seeking any coverage must: 1. Cooperate with us in the investigation, settlement, or defense of any claim or suit including access to any data available from "your covered auto s" or "non-owned auto s" Event Data Recorder. 2. Promptly send us copies of any notices or legal papers received in connection with the accident or loss. 3. Submit, as often as we reasonably require: a. To physical exams by physicians we select. We will pay for these exams. b. To examination under oath and subscribe the same. 4. Authorize us to obtain: a. Medical reports; and b. Other pertinent records. 5. Submit a proof of loss when required by us. C. A person seeking Uninsured Motorists Coverage, Underinsured Motorists Coverage, or Uninsured Motorists Property Damage Coverage must also: 1. Promptly notify the police if a hit-and-run driver is involved. 2. Promptly send us copies of the legal papers if a suit is brought. D. A person seeking Coverage for Damage to Your Auto must also: 1. Take reasonable steps after loss to protect "your covered auto" or any "non-owned auto" and their equipment from further loss. We will pay reasonable expenses incurred to do this. 2. Promptly notify the police if "your covered auto" or any "non-owned auto" is stolen or of any theft loss. 3. Permit us to inspect and appraise the damaged property before its repair or disposal including access to any data available from "your covered auto s" or "nonowned auto s" Event Data Recorder. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 19 of 22

41 A-10-NH (08-13) PART G - GENERAL POLICY PROVISIONS BANKRUPTCY Bankruptcy or insolvency of the "insured" shall not relieve us of any obligations under this policy. CHANGES A. This policy contains all the agreements between you and us. Its terms may not be changed or waived except by endorsement issued by us. B. If there is a change to the information used to develop the policy premium, we may adjust your premium. Changes during the policy term that may result in a premium increase or decrease include, but are not limited to, changes in: 1. The number, type, or use classification of insured vehicles; 2. Operators using insured vehicles; 3. The place of principal garaging of insured vehicles; 4. Coverage, deductible, or limits; or 5. Operators' driving record. If a change resulting from A. or B. requires a premium adjustment, we will make the premium adjustment in accordance with our manual rules. C. If we make a change which broadens coverage under this edition of your policy without additional premium charge, that change will automatically apply to your policy as of the date we implement the change in your state. This Paragraph (C.) does not apply to change(s) implemented with a general program revision that includes both broadenings and restrictions in coverage, whether that general program revision is implemented through introduction of: 1. A subsequent edition of your policy; or 2. An Amendatory Endorsement. FRAUD We do not provide coverage for any "insured" who has: 1. Falsely attested to being a New Hampshire resident on the Statement of Residency required by N.H. Rev. Stat. Ann. Section 417-A. However, we do provide coverage for that "insured" for "bodily injury" or "property damage" for which that "insured" becomes legally responsible because of an auto accident. If we make a payment for "bodily injury" or "property damage" for which that "insured" becomes legally responsible, we are entitled to reimbursement for all such payments in accordance with the Our Right To Recover Payment Provision contained in this policy. 2. Made fraudulent statements or engaged in fraudulent conduct in connection with any accident or loss for which coverage is sought under this policy. LEGAL ACTION AGAINST US A. No legal action may be brought against us until there has been full compliance with all the terms of this policy. In addition, under Part A - Liability Coverage, no legal action may be brought against us until: 1. We agree in writing that the "insured" has an obligation to pay; or 2. The amount of that obligation has been finally determined by judgment after trial. B. No person or organization has any right under this policy to bring us into any action to determine the liability of an "insured". OUR RIGHT TO RECOVER PAYMENT A. If we make a payment under this policy and the person to or for whom payment was made has a right to recover damages from another, we shall be subrogated to that right. That person shall do: 1. Whatever is necessary to enable us to exercise our rights; and 2. Nothing after loss to prejudice them. However, our rights in this Paragraph (A.) do not apply under Part D - Coverage For Damage To Your Auto, against any person using "your covered auto" with a reasonable belief that that person is entitled to do so. Our rights do not apply under Paragraph A. with respect to damages an "insured" is legally entitled to recover from the owner or operator of an "underinsured motor vehicle" if we: 1. Have been given prompt written notice of a tentative settlement between an "insured" and the insurer of an "underinsured motor vehicle"; and 2. Fail to advance payment to the "insured" in an amount equal to the tentative settlement within 30 days after receipt of notification. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 20 of 22

42 A-10-NH (08-13) If we advance payment to the "insured" in an amount equal to the tentative settlement within 30 days after receipt of notification: 1. That payment will be separate from any amount the "insured" is entitled to recover under the provisions of Uninsured Motorists and Underinsured Motorists Coverage; and 2. We also have a right to recover the advanced payment. B. If we make a payment under: 1. Part C of this policy, we shall be entitled to a recovery under Paragraph A. or B. only after the person has been fully compensated for damages. 2. Part A or Part C of this policy and any "insured" under this policy has falsely attested to being a New Hampshire resident on the Statement of Residency required by N.H. Rev. Stat. Ann. Section 417-A, that "insured" shall reimburse us to the extent of our payment. C. If we make a payment under this policy and the person to or for whom payment is made recovers damages from another, that person shall: 1. Hold in trust for us the proceeds of the recovery; and 2. Reimburse us to the extent of our payment. OUR RIGHT TO RECOVER EARNED PREMIUM If we make payment under this policy for any covered loss which occurs prior to the effective date of cancellation and there is earned premium due, we shall have the right to deduct any earned premium due from monies paid in settlement of the loss. POLICY PERIOD AND TERRITORY A. This policy applies only to accidents and losses which occur: 1. During the policy period as shown in the Declarations; and 2. Within the policy territory. B. The policy territory is: 1. The United States of America, its territories, or possessions; 2. Puerto Rico; or 3. Canada. This policy also applies to loss to, or accidents involving, "your covered auto" while being transported between their ports. TERMINATION A. Cancellation This policy may be cancelled during the policy period as follows: 1. The named insured shown in the Declarations may cancel by: a. Returning this policy to us; or b. Giving us advance written notice of the date cancellation is to take effect. 2. We may cancel by mailing to the named insured shown in the Declarations at the address shown in this policy: a. At least 10 days' notice: (1) If cancellation is for nonpayment of premium; or (2) If notice is mailed during the first 60 days this policy is in effect and this is not a renewal or continuation policy; or b. At least 45 days' notice in all other cases. 3. After this policy is in effect for 60 days, or if this is a renewal or continuation policy, we will cancel only for nonpayment of premium. B. Nonrenewal If we decide not to renew or continue this policy, we will mail notice to the named insured shown in the Declarations at the address shown in the policy. Notice will be mailed at least 45 days before the end of the policy period. Subject to this notice requirement, if the policy period is other than one year, we will have the right not to renew or continue it only at each anniversary of its original effective date. C. Automatic Termination If we offer to renew or continue and you or your representative do not accept, this policy will automatically terminate at the end of the current policy period. Failure to pay the required renewal or continuation premium when due shall mean that you have not accepted our offer. D. Other Termination Provisions 1. We may deliver any notice instead of mailing it. Proof of mailing of any notice shall be sufficient proof of notice. 2. If this policy is cancelled, you may be entitled to a premium refund. If so, we will send you the refund. The premium refund, if any, will be computed according to our manuals. However, making or offering to make the refund is not a condition of cancellation. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 21 of 22

43 A-10-NH (08-13) 3. The effective date and time of cancellation stated in the notice shall become the end of the policy period. CONFORMITY TO STATUTE Terms of this policy which are in conflict with the statutes of the states wherein this policy is issued are hereby amended to conform to such statutes. TRANSFER OF YOUR INTEREST IN THIS POLICY A. Your rights and duties under this policy may not be assigned without our written consent. However, if a named insured shown in the Declarations dies, coverage will be provided for: 1. The surviving spouse if resident in the same household at the time of death. Coverage applies to the spouse as if a named insured shown in the Declarations; and 2. The legal representative of the deceased person as if a named insured shown in the Declarations. This applies only with respect to the representative's legal responsibility to maintain or use "your covered auto". B. Coverage will only be provided until the end of the policy period. TWO OR MORE AUTO POLICIES If this policy and any other auto insurance policy issued to you by us, or a member Company of the Ohio Mutual Insurance Group, apply to the same accident, the maximum limit of our liability under all the policies shall not exceed the highest applicable limit of liability under any one policy. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-10-NH (08-13).DOC Page 22 of 22

44 A-101-NH (08-13) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED DRIVER EXCLUSION ENDORSEMENT - NEW HAMPSHIRE In consideration of the continuation of this policy for the current and all successive policy periods, it is understood and agreed that the excluded driver(s) shown in the Declarations is excluded from any coverages provided by this policy while driving or operating "your covered auto(s)" or any other auto. With respect to PART A - LIABILITY COVERAGE, coverage is limited to the minimum limits required by the financial responsibility law of New Hampshire. All other provisions, limitations, exclusions, conditions, and definitions of this policy apply. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-101-NH (08-13).DOC Page 1 of 1

45 A-125 NH (08-13) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MISCELLANEOUS TYPE VEHICLE ENDORSEMENT - NEW HAMPSHIRE NOTICE: The amount shown in the Declarations is not necessarily the amount you will receive at the time of loss or damage for the described property. Please refer to the Limit of Liability provision. This coverage is subject to all the provisions of the policy with respect to the miscellaneous type vehicles and coverages described in the Declarations except as modified as follows: I. DEFINITIONS The Definitions section is amended as follows: A. For the purpose of the coverage provided by this endorsement, miscellaneous type vehicle means a motor home, motorcycle, utility trailer, camping trailer, all-terrain vehicle, or golf cart. This includes such equipment that is built into and forms a permanent part of the vehicle. It does not include radio or television antennas, awnings, cabanas, equipment designed to create additional living facilities, or personal property, except to the extent that coverage is provided under Part D - Coverage For Damage To Your Auto - under Camping Vehicles - Awning and Camping Vehicles - Contents. B. The definition of "your covered auto" is replaced by the following: "Your covered auto" means: 1. Any "miscellaneous type vehicle" shown in the Declarations. 2. A "newly acquired auto". 3. Any "trailer". 4. Any "miscellaneous type vehicle" or auto you do not own while used as a temporary substitute for any other vehicle described in this definition which is out of normal use because of its: a. Breakdown; b. Repair; c. Servicing; d. Loss; or e. Destruction. This provision (4.) does not apply to Coverage for Damage to Your Auto. C. Paragraph 1. of the definition of "newly acquired auto" is replaced by the following: 1. "Newly acquired auto" means any of the following types of vehicles you become the owner of during the policy period: a. A private passenger auto; b. A pickup or van, for which no other insurance policy provides coverage, that: (1) Has a Gross Vehicle Weight of less than 12,500 lbs.; and (2) Is not used for the delivery or transportation of goods and materials unless such use is: (a) Incidental to your "business" of installing, maintaining or repairing furnishings or equipment; or (b) For farming or ranching; or c. Any "miscellaneous type vehicle" of the same type shown in the Declarations. II. PART A - LIABILITY COVERAGE Part A is amended as follows: A. The definition of insured is replaced by the following: Insured means: 1. You or any family member for the ownership, maintenance, or use of your covered auto. 2. You or any "family member" for the maintenance or use of any motor vehicle as defined in N.H. Code Admin. R Any person using your covered auto with your permission provided the actual operation or use is within the scope of such permission. Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-125 NH (08-13).DOC Page 1 of 3

46 A-125 NH (08-13) 4. For your covered auto, any person or organization but only with respect to legal responsibility for acts or omissions of a person for whom coverage is afforded under this Part. B. The Exclusions Section is amended as follows: 1. Exclusion B.1. is replaced by the following: We do not provide Liability Coverage for the ownership, maintenance, or use of any vehicle which: a. Has fewer than four wheels; or b. Is designed mainly for use off public roads. This Exclusion (B.1.) does not apply: a. While such vehicle is being used by an "insured" in a medical emergency; b. To any motorcycle or "trailer"; or c. To a vehicle insured for Liability Coverage under this endorsement. III. PART B - MEDICAL PAYMENTS COVERAGE Exclusion 1. of Part B is replaced by the following: We do not provide Medical Payments Coverage for any "insured" for "bodily injury" sustained while "occupying" any motorized vehicle having fewer than four wheels. However, this Exclusion (1.) does not apply to: a. A motorized vehicle having fewer than four wheels if it is insured for Medical Payments Coverage under this endorsement; or b. Any motorcycle. IV. PART D - COVERAGE FOR DAMAGE TO YOUR AUTO Part D is amended as follows: A. The following is added to the definition of non-owned auto : 3. Any motor home, motorcycle, utility trailer, camping trailer, all-terrain vehicle, or golf cart you do not own while used as a temporary substitute for your covered auto which is out of normal use because of its: a. Breakdown; b. Repair; c. Servicing; d. Loss; or e. Destruction. B. With respect to the Coverage(s) shown as applicable to a vehicle described in the Declarations, the Limit of Liability provision is replaced by the following: Limit of Liability A. Our limit of liability for loss will be the lesser of the: 1. Amount shown in the Declarations; 2. Actual cash value of the stolen or damaged property; or 3. Amount necessary to repair or replace the property with other property of like kind and quality. Our payment for loss will be reduced by any applicable deductible shown in the Declarations. If loss to more than one your covered auto results from the same collision, only the highest applicable deductible will apply. B. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of loss. C. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. D. If the damaged property was previously damaged but you did not have it repaired or replaced, we will reduce the amount payable for the loss by the amount of the previous damage. E. If you agree to repair instead of replace your damaged windshield, we will pay the full cost of repairing the windshield regardless of your deductible. F. We will not make a duplicate payment under this coverage for any element of loss for which payment has been made, including payments made by or on behalf of persons or organizations who may be legally responsible. V. EXCLUSIONS A. The following additional exclusions apply to any motor home which is your covered auto. 1. Part A - Liability Coverage Exclusion We do not provide Liability Coverage for the ownership, maintenance, or use of any motor home while rented or leased to any organization, or any insured other than you. However, this exclusion does Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-125 NH (08-13).DOC Page 2 of 3

47 A-125 NH (08-13) not apply up to the financial responsibility limits of any compulsory insurance law applicable to the state in which your covered auto is principally garaged. 2. Part B - Medical Payments Coverage Exclusion We do not provide Medical Payments Coverage for any insured for bodily injury sustained while occupying the motor home while it is rented or leased to any organization, or any insured other than you. 3. Part D - Coverage For Damage To Your Auto Exclusion We will not pay for loss to the motor home or its facilities or equipment which occurs while the motor home is rented or leased to any organization, or any person other than you. B. The following additional exclusion also applies to any motor home which is your covered auto regardless of any other coverage which may be afforded by this endorsement: Part D - Coverage For Damage To Your Auto Exclusion We will not pay for loss to the motor home or its facilities or equipment due to fraudulent acquisition by any person or organization, which occurs while the motor home is: 1. Rented to; 2. Used by; or 3. In the care of that person or organization. All other provisions of this policy apply. Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-125 NH (08-13).DOC Page 3 of 3

48 A-131 (10-06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - LESSOR Any liability coverages afforded by this policy for "your leased auto" also apply to the lessor named in the Declarations as an additional insured. This insurance is subject to the following additional provisions: 1. We will pay damages for which the lessor becomes legally responsible only if the damages arise out of acts or omissions of: a. You or any "family member", or b. Any other person except the lessor or any employee or agent of the lessor using "your leased auto". 2. "Your leased auto" means: a. An auto shown in the Declarations which you lease for a continuous period of at least six months under a written agreement which requires you to provide primary insurance for the lessor, and b. Any substitute or replacement auto furnished by the lessor shown in the Declarations. 3. If we terminate this policy, notice will also be mailed to the lessor. 4. The lessor is not responsible for payment of premiums. 5. The designation of the lessor as an additional insured shall not operate to increase our limits of liability. All other provisions of this policy apply. Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-131 (10-06).DOC Page 1 of 1

49 A-140 (10-06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CLASSIC AUTO COVERAGE ENDORSEMENT (MAXIMUM LIMIT OF LIABILITY) NOTICE: The amount shown in the Declarations is not necessarily the amount you will receive at the time of loss or damage for the described property. Please refer to the Limit of Liability provision below. With respect to the Coverage(s) shown as applicable to the vehicle(s) described in the Declarations, the Limit of Liability provision in Part D - Coverage For Damage To Your Auto - is replaced by the following: LIMIT OF LIABILITY A. Our limit of liability for loss will be the lesser of the: 1. Amount shown in the Declarations; 2. Actual cash value of the stolen or damaged property; or 3. Amount necessary to repair or replace the property with other property of like kind and quality. Our payment for loss will be reduced by any applicable deductible shown in the Declarations. If loss to more than one your covered auto results from the same collision, only the highest applicable deductible will apply. B. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of loss. C. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. All other provisions of this policy apply. Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-140 (10-06).DOC Page 1 of 1

50 A-145 (10-06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ANTIQUE AUTOMOBILE ENDORSEMENT NOTICE: The amount shown in the Declarations is not necessarily the amount you will receive at the time of loss or damage for the described property. Please refer to the Limit of Liability provision below. We agree that with respect to loss to your covered auto, the Limit of Liability provision in Part D - Coverage For Damage To Your Auto - is replaced by the following: LIMIT OF LIABILITY A. Our limit of liability for loss will be the lesser of the: 1. Amount shown in the Declarations; 2. Actual cash value of the stolen or damaged property; or 3. Amount necessary to repair or replace the property with other property of like kind and quality. Our payment for loss will be reduced by any applicable deductible shown in the Declarations. If loss to more than one your covered auto results from the same collision, only the highest applicable deductible will apply. B. An adjustment for depreciation and physical condition will be made in determining actual cash value at the time of loss. C. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. All other provisions of this policy apply. Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-145 (10-06).DOC Page 1 of 1

51 A-150 (12-10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO PLUS COVERAGE ENDORSEMENT This package of extra coverage is provided at no charge to you on all subsequent renewals, if all members of the household are at least 45 years of age and the Auto/Home Discount applies to this auto policy. RENTED VEHICLE COVERAGE This coverage is subject to all the provisions of your policy except as changed herein. When there is loss or damage to a "non-owned auto" that you rent for less than 90 consecutive days, we will pay for direct and accidental loss to the "non-owned auto" that you rent including its equipment, not otherwise excluded, and actual loss of use up to $30 per day with a maximum of $900. No deductible or waiting periods apply to this coverage. Duplicate payments will not be made for the same elements of loss. This coverage is not contingent upon physical damage coverage being provided for "your covered auto". EMERGENCY TRAVEL EXPENSE We will pay up to $250 for travel expenses incurred because of loss to "your covered auto" more than 50 miles from your legal residence provided the loss is covered under this policy. No deductible applies to this coverage. Emergency Travel Expense means: 1. Lodging, including meals, and/or transportation back to your legal residence. 2. Returning "your covered auto" to its garage location, unless we declare it a total loss. This limit is in addition to the transportation limit provided by this policy. EMERGENCY AMBULANCE EXPENSE We will pay up to $2,500 for emergency ambulance service or other necessary means of transportation as directed by professional medical emergency personnel for transportation to a hospital because of "bodily injury" sustained by you or any "family member" and caused by an auto accident. LOCKSMITH SERVICES We will pay up to $100 for necessary locksmith services incurred because keys to "your covered auto" or a "non-owned auto" have been lost or stolen. No deductible applies to this coverage. DEATH INDEMNITY COVERAGE We will pay $10,000 for each accidental death of you or any "family member" because of "bodily injury" caused by an auto accident. This coverage applies only if you or a "family member" dies as a result of "bodily injury" sustained in an auto accident within 90 days of the date of the accident. This benefit is in addition to ACCIDENTAL DEATH COVERAGE, if shown in the Declarations of this policy. EXCLUSIONS This coverage does not apply to: 1. Bodily injury or death sustained by you or any family member in the course of their occupation while engaged in duties incident to the: a. Operation, loading or unloading of, or as an assistant on, a public livery conveyance or commercial auto, or b. Repair or servicing of autos. 2. Suicide, sane or insane, or to any attempt thereat. 3. Injury or death due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing. TWO OR MORE AUTO POLICIES If this policy and any other auto insurance policy issued to you or any family member by us, or a member Company of the Ohio Mutual Insurance Group, applies to the same accident for DEATH INDEMNITY COVERAGE, the maximum limit we will pay is $10,000 per person regardless of the number of policies. PAYMENT OF DEATH INDEMNITY COVERAGE If the decedent is survived by a spouse who was a resident of the same household at the time of the auto accident, Death Indemnity Coverage is payable to such spouse; otherwise, if the decedent was a minor, Death Indemnity Coverage is payable to any parent thereof who was a resident of the same household at the time of the auto accident; otherwise, Death Indemnity Coverage is payable to the estate of the decedent. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-150 (12-10).DOC Page 1 of 2

52 A-150 (12-10) NOT AT FAULT ACCIDENT In the event of a covered loss under PART D COVERAGE FOR DAMAGE TO YOUR AUTO, the following deductible waiver applies: If there is a covered loss to a non-owned auto or your covered auto shown in the Declarations for which Collision Coverage is afforded, and we determine that you or any driver shown in the Declarations are not at fault, we will not apply the applicable Collision Deductible if the driver of the other vehicle is identified, and has applicable insurance coverage. All other provisions of this policy apply. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-150 (12-10).DOC Page 2 of 2

53 A-155 (10-06) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRUST ENDORSEMENT With respect to the coverage provided by this endorsement, the provisions of the policy apply unless modified by the endorsement. I. Definitions The following is added to Paragraph C. of the Definitions Section: For purposes of this policy, a private passenger type auto, pickup, or van shall be deemed to be owned by a person if title is transferred to the trust shown in the Declarations. II. Part G. General Policy Provisions Part G is amended as follows: The following is added to the Termination provision: If this policy is terminated, notice will also be mailed to the Trustee(s) shown in the Declarations. All other provisions of this policy apply. Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-155 (10-06).DOC Page 1 of 1

54 A-165 (06-10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNER/TITLEHOLDER ENDORSEMENT Coverage afforded under Part A - Liability Coverage by this policy for "your covered auto" also applies to the owner/titleholder named in the Declarations as an Additional Insured - Owner/Titleholder. 1. If we terminate this policy, notice will also be mailed to the owner/titleholder. 2. The designation of the owner/titleholder as an additional insured shall not operate to increase our limits of liability. All other provisions of this policy apply. A-165 (06-10).DOC Page 1 of 1

55 A-170-NH (08-13) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOW SPEED VEHICLE ENDORSEMENT - NEW HAMPSHIRE With respect to the "low speed vehicles" and coverages described in the Declarations, the provisions of the policy apply unless modified by this endorsement. I. DEFINITIONS The Definitions Section is amended as follows: A. For the purpose of the coverage provided by this endorsement, "low speed vehicle" means a four-wheeled motor vehicle, other than a truck, whose top speed is more than 20 miles per hour and not more than 25 miles per hour on paved surfaces and complies with the safety standards established under New Hampshire law. B. The definition of "your covered auto" is replaced by the following: "Your covered auto" means: 1. Any "low speed vehicle" shown in the Declarations. 2. A "newly acquired auto". 3. A "trailer". 4. Any "low speed vehicle" or auto you do not own while used as a temporary substitute for any other vehicle described in this definition which is out of normal use because of its: a. Breakdown; b. Repair; c. Servicing; d. Loss; or e. Destruction. This Provision (4.) does not apply to Coverage for Damage to Your Auto. C. Paragraph 1. of the definition of "newly acquired auto" is replaced by the following: 1. "Newly acquired auto" means any of the following types of vehicles you become the owner of during the policy period: a. A private passenger auto; b. A pickup or van, for which no other insurance policy provides coverage, that: (1) Has a Gross Vehicle Weight of less than 12,500 lbs; and (2) Is not used for the delivery or transportation of goods and materials unless such use is: (a) Incidental to your "business" of installing, maintaining, or repairing furnishings or equipment; or (b) For farming or ranching; or c. Any "low speed vehicle". II. PART A - LIABILITY COVERAGE Part A is amended as follows: A. The definition of "insured" is replaced by the following: "Insured" means: 1. You or any "family member" for the ownership, maintenance or use of: a. "Your covered auto"; or b. Any motor vehicle as defined in N.H. Code Admin. R Any person using "your covered auto" with your permission provided that the actual operation or use is within the scope of such permission. 3. For "your covered auto", any person or organization but only with respect to legal responsibility for acts or omissions of a person for whom coverage is afforded under this Part. B. Exclusion B.1. is replaced by the following: We do not provide Liability Coverage for the ownership, maintenance, or use of any vehicle which is designed mainly for use off public roads. This Exclusion (B.1.) does not apply: 1. While such vehicle is being used by an "insured" in a medical emergency; 2. To any "trailer"; or 3. To a vehicle insured for Liability Coverage. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-170-NH (08-13).DOC Page 1 of 2

56 A-170-NH (08-13) III. PART D - COVERAGE FOR DAMAGE TO YOUR AUTO Part D is amended as follows: The following is added to the definition of "nonowned auto": 3. Any "low speed vehicle" you do not own while used as a temporary substitute for "your covered auto" which is out of its normal use because of its: a. Breakdown; b. Repair; c. Servicing; d. Loss; or e. Destruction. Includes copyrighted material of Insurance Services Office, Inc., with its permission. A-170-NH (08-13).DOC Page 2 of 2

57 A-396 (11-93) EXTENDED NON-OWNED COVERAGE FOR NAMED INDIVIDUAL 1. Part A - Liability Coverage - of the policy is amended as follows with respect to Exclusion B.2.b. so as not to apply to individual(s) named below. 2. Part B - Medical Payments Coverage - of the policy is amended as follows if a premium is shown on the Declarations for Medical Payments with respect to the individual named on this endorsement. a. Exclusion 5.b. does not apply. 3. This endorsement does not afford coverage under Part A - Liability Coverage - or Part B - Medical Payments Coverage - of the policy for any accident involving a vehicle owned by the individual named below or by a member of the same household, or any accident involving a temporary substitute vehicle for such owned vehicle Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-396 (11-93).DOC Page 1 of 1

58 A-397 (12-10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NAMED NON-OWNER COVERAGE This coverage is subject to all provisions of the policy with respect to individuals and coverages described in the Declarations except as modified as follows: Name of individual(s) covered: Coverages shown in this endorsement do not apply unless shown in the Declarations and unless a premium charge is shown for each coverage in the Declarations. I. DEFINITIONS The Definitions section is amended as follows: A. The definitions of "you" and "your" are replaced by the following: "You" or "your" refers to the individual named in this endorsement. B. The definition of "your covered auto" is replaced by the following: "Your covered auto" means a "newly acquired auto". C. The definition of "newly acquired auto" is replaced by the following: "Newly acquired auto" means any of the following types of vehicles on the date you become the owner: 1. A private passenger auto; or 2. A pickup or van that: a. Has a gross vehicle weight of less than 12,500 lbs.; and b. Is not used for the delivery or transportation of goods and materials unless such use is: (1) Incidental to your "business" of installing, maintaining, or repairing furnishings or equipment; or (2) For farming or ranching. This provision applies only: (1) If you acquire the vehicle during the policy period; and (2) For 30 days after you become the owner. This insurance does not apply if other insurance applies with respect to newly acquired vehicles. II. PART A - LIABILITY COVERAGE Part A is amended as follows: A. Paragraph B.1. of the definition of "insured" is amended by deleting reference to "family member". B. The Exclusions section is amended as follows: 1. Exclusions A.7. and A.8. are replaced by the following: We do not provide Liability Coverage for any "insured" maintaining or using any vehicle in the "business" of that "insured". This exclusion does not apply to an auto operated or occupied by you. 2. Exclusion B.2. is replaced by the following: We do not provide Liability Coverage for the ownership, maintenance, or use of any vehicle, other than "your covered auto", which is owned by you. 3. Exclusion B.3. is replaced by the following: We do not provide Liability Coverage for the ownership, maintenance, or use of any vehicle other than "your covered auto", which is owned by any "family member". However, this exclusion (B.3.) does not apply to you while you are maintaining or "occupying" any vehicle which is owned by a "family member". Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-397 (12-10).DOC Page 1 of 2

59 A-397 (12-10) C. The Out of State Coverage provision is replaced by the following: OUT OF STATE COVERAGE If an auto accident to which this policy applies occurs in any state or province other than where you reside, we will interpret your policy for that accident as follows: A. If the state or province has: 1. A financial responsibility or similar law specifying limits of liability for "bodily injury" or "property damage" higher than the limit shown in the Declarations, your policy will provide the higher specified limit. 2. A compulsory insurance or similar law requiring a nonresident to maintain insurance whenever the nonresident uses a vehicle in that state or province, your policy will provide at least the required minimum amounts and types of coverage. B. No one will be entitled to duplicate payments for the same elements of loss. 2. Exclusion 6. is replaced by the following: We do not provide Medical Payments Coverage for any "insured" for "bodily injury" sustained while "occupying", or when struck by, any vehicle (other than "your covered auto") which is owned by any "family member". However, this Exclusion (6.) does not apply to you. IV. PART C - UNINSURED MOTORISTS AND UNDERINSURED MOTORISTS COVERAGE Part C is amended as follows: A. Paragraph B.1. of the definition of "insured" is amended by deleting reference to "family member". All other provisions of this policy apply. III. PART B - MEDICAL PAYMENTS COVERAGE Part B is amended as follows: A. The Exclusions section is amended as follows: 1. Exclusion 5. is replaced by the following: We do not provide Medical Payments Coverage for any "insured" for "bodily injury" sustained while "occupying" or when struck by, any vehicle (other than "your covered auto") which is owned by you. Includes copyrighted material of Insurance Services Office, Inc. with its permission. A-397 (12-10).DOC Page 2 of 2

60 CEF-286-NH (08-13) OHIO MUTUAL INSURANCE GROUP 1725 Hopley Avenue, P.O. Box 111 Bucyrus, Ohio (800) Fax (888) NAMED DRIVER EXCLUSION FORM - NEW HAMPSHIRE (This form is to be used only with Personal Auto Policies.) In consideration of the issuance or continuation of the policy requested or in force for the current and all successive policy periods, it is understood and agreed that no coverage is afforded by this policy when "your covered auto(s)" or any other auto is being driven or operated by the following named individual: With respect to PART A - LIABILITY COVERAGE, coverage is limited to the minimum limits required by the financial responsibility law of New Hampshire. The excluded operator, insured, and spouse, if married, and residing in the same household, accept this exclusion and witness such signatures. Excluded Operator Insured Spouse Effective Date Policy Number Coverage Provided by: Casco Indemnity Company, Ohio Mutual Insurance Company, or United Ohio Insurance Company CEF-286-NH (08-13).DOC Page 1 of 1

61 More than a promise Hopley Avenue, P.O. Box 111 Bucyrus, Ohio omig.com <INSURED NAME> <INSURED ADDRESS> <CITY, STATE ZIP> Date: Policy No.: Reference No.: We value your business, and appreciate the confidence and trust that you have placed in Ohio Mutual Insurance Group and X, your independent agent. Developing premiums that are fair to our Policyholders involves the consideration of many factors about the insured individuals (such as driving records, prior loss history, and credit/insurance scores) and the property being insured (the make/model of an insured vehicle, materials used in construction for an insured home, and the physical location of the insured property). If you are shopping for insurance or if your current policy is up for renewal, we may be consulting a variety of consumer reports including motor vehicle reports (driving and accident records), Comprehensive Loss Underwriting Exchange (CLUE) reports, and credit-based insurance score reports in order to help us measure your risk of having an insurance loss. Some of these factors, such as insurance scoring, can provide significant credits to your final premium. Based on the information obtained from your consumer reports, the rate assigned to your enclosed policy may not be the lowest possible rate we offer, but it is the best rate available to you, based on all the factors we consider. While most insurance companies may gather similar information, each company evaluates and weighs the information independently to determine rates for its own insurance products. The credit-based insurance scores used to help determine your insurance rate are calculated by analyzing a number of factors, and are separate and different from the credit scores financial institutions may use to determine your credit-worthiness. If we have included reason codes and explanations at the end of this letter, those are the factors that had the greatest impact on your insurance score. A more detailed description of these reason codes can be found at Within 60 days of the date of this letter, you may obtain a free copy of the consumer reports we have obtained from LexisNexis, the consumer reporting agency that delivers credit information to our company, through any of the following means: access the LexisNexis website at call LexisNexis toll-free at (automated service is available 24 hours a day, 7 days a week) CEF-357 (03-13).doc Passionate Innovative Partnership

62 write LexisNexis at the following address: LexisNexis Consumer Center, P.O. Box , Atlanta, GA LexisNexis does not make any decision regarding how your premium is determined and is unable to provide any specific information regarding those decisions. Under the federal Fair Credit Reporting Act (FCRA), you have the right to know and review the accuracy of information provided to us through the consumer reports we have received. You also have the right to obtain a free report every 12 months from consumer reporting agencies. If you identify information in your personal consumer report that you question, the reporting agency must investigate it, and remove it within 30 days if it is found to be inaccurate, incomplete, or unverifiable. In addition, negative information must be removed after seven years (bankruptcies after 10 years). A summary of your rights under the FCRA including how to obtain or dispute inaccurate or incomplete information is available at or by writing Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC You may be able to sue for violations of the FCRA in state or federal court. Your state may offer additional protections for details, contact your state Attorney General. As indicated earlier in the letter, the Reason Codes most affecting your insurance score are: <CODE1> <CODE2> <CODE3> <CODE4> Thank you once again for choosing our company to provide your insurance protection. If you have any questions regarding the information in this letter, please contact your Agent, who will welcome your call. If you are unable to reach your Agent, you may contact us for assistance at Ohio Mutual Insurance Group

63 IL P U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided. This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully. The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of "national emergency". OFAC has identified and listed numerous: Foreign agents; Front organizations; Terrorists; Terrorist organizations; and Narcotics traffickers; as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's web site http// In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply. IL P ISO Properties, Inc., 2004 Page 1 of 1

64 SIG-1 (01-12) SIGNATURE PAGE In witness whereof, we have caused this policy to be executed and attested, and if required by state law this policy shall not be valid unless countersigned by our authorized representative. UNITED OHIO INSURANCE COMPANY OHIO MUTUAL INSURANCE COMPANY CASCO INDEMITY COMPANY James J. Kennedy, President David Hendrix, Chief Financial Officer SIG-1 (01-12).DOC TOLL FREE: Page 1 of 1

65 OHIO MUTUAL INSURANCE GROUP 1725 Hopley Avenue, P.O. Box 111 Bucyrus, Ohio (800) Fax (888) NOTICE OF COMPANY INFORMATION PRACTICES We are sending this notice to ALL United Ohio Insurance Company, Ohio Mutual Insurance Company, and Casco Indemnity Company policyholders to comply with the Gramm-Leach-Bliley Act (GLBA) and other legislation or rules regarding your privacy. This notice is being provided to advise you of our information gathering practices when you apply for insurance or when your policy is renewed. We collect nonpublic personal information about you and members of your household, in connection with your insurance transactions with us. Personal Information about you, including credit history or insurance score may be obtained and used in connection with underwriting or rating your policy. Other information may be collected from persons other than you in connection with your insurance coverage and subsequent renewals. The type of information collected may vary depending on the type of insurance policy or coverage you desire, and it may include: Information we receive from you on applications and other forms; Information about your transactions with us, our affiliates or others; Information we receive from consumer reporting agencies and other sources: and With your permission, information from a medical professional. We DO NOT DISCLOSE any nonpublic personal information about our policyholders or former policyholders to anyone, except as permitted by law. We DO NOT RESELL or provide any information we gather to third parties that may wish to provide you with information about their products and services. On your behalf and for your protection, we have exercised your option to Opt Out of disclosing your non-public personal information to nonaffiliated third parties. We will keep this on record, which eliminates your need to notify us. X I wish to "Opt Out" of disclosing my nonpublic personal information to nonaffiliated third parties. As part of servicing or maintaining your policy, and for legally permitted purposes, we can disclose your nonpublic personal information among affiliated companies. In certain instances, the law also permits us to disclose your nonpublic personal information to third parties without your authorization. You have a right to obtain access to your nonpublic personal information that we have recorded. You also have the right to correct inaccurate information by writing to us at the above address with your concerns. We restrict access to your nonpublic personal information to our employees and others who need to know that information in order to provide products and services to you. We maintain security over our records to protect your personal information as required by law. If you desire more details about our information practices, your rights to access and to request changes to your nonpublic personal information in our files, please contact us at the above address. THIS FORM DOES NOT HAVE TO BE RETURNED. UOI-101 (01-12).DOC Page 1 of 1

66 United Ohio Insurance Co. P.O. Box 111. Bucyrus, OH NEW BUSINESS DECLARATION Transaction MASTERS SERIES - PERSONAL AUTO DECLARATION Policy Period Policy Number From To AMS /12/ /12/2014 Pay Plan Annl 2-Pay SAMPLE POLICY MRS POLICY STREET ADDRESS AUBURN NH Named Insured and Address AGENT NAME AND ADDRESS Agent Telephone: AGENT PHONE NUMBER AND CODE DESCRIPTION OF COVERED VEHICLES, LIMITS OF LIABILITY - COVERAGE IS PROVIDED WHERE A PREMIUM AND/OR LIMIT OF LIABILITY IS SHOWN. THE VEHICLES ARE PRINCIPALLY GARAGED AT THE INSURED'S ADDRESS UNLESS STATED BELOW: MAKE MODEL YEAR VEHICLE IDENTIFICATION NUMBER VEHICLE 1 VEHICLE 2 VEHICLE VEHICLE HYUNDAI VERACRUZ GLS AWD/ 2010 KM8NUDCC(A MAZDA MAZDA3 S/S TOURIN 2006 JM1BK OTHER THAN COLLISION SYMBOL COLLISION SYMBOL USE RATING CLASS STATE & TERRITORY RATED DRIVER DISCOUNTS KJ KK Work 8172M0 NH PR AB ET MC ST DR DX Pleasure 8161K0 NH AT PR MC ST PER PER COVERAGE PERSON ACCIDENT PREMIUM DED PREMIUM DED PREMIUM DED PREMIUM DED LIMIT LIMIT BODILY INJURY LIABILITY 100, , PROPERTY DAMAGE LIABILITY 100, MEDICAL PAYMENTS 5, OTHER THAN COLLISION COLLISION COVERAGE UNINSURED / UNDERINSURED 100, , MOTORISTS BODILY INJURY TRANSPORTATION EXPENSES 20 PER DAY 600 MAX INCL OPTIONAL TRANSPORTATION 30 PER DAY 900 MAX TOWING & LABOR VEHICLE PREMIUM TOTAL $ $ POLICY PREMIUM TOTAL (THIS IS NOT AN INVOICE FOR PAYMENT) AT = Anti-Theft Equipment PR = Passive Restraint AB = Anti-lock Braking System ET = Elite Discount MC = Multi-Car ST = Starter Discount $ 1, Issued Date: 04/21/2013 AGENT ONLINE COPY Page 1 of 2

67 United Ohio Insurance Co. P.O. Box 111. Bucyrus, OH NEW BUSINESS DECLARATION Transaction MASTERS SERIES - PERSONAL AUTO DECLARATION Policy Period Policy Number From To AMS /12/ /12/2014 Pay Plan Annl 2-Pay SAMPLE POLICY MRS POLICY STREET ADDRESS AUBURN NH Named Insured and Address AGENT NAME AND ADDRESS Telephone: Agent AGENT PHONE NUMBER AND CO DE Driver(s) on the Policy Birth Mar Sex 1 SAMPLE POLICY 05/08/1962 M M Violation Violation Date STOP SIGN VIOLATION 12/28/2012 Driver(s) on the Policy Birth Mar Sex 2 MRS POLICY 07/18/1963 M F Included in the Policy Premium Total is a surcharge of $ as a result of an accident(s) and/or violation(s). A surcharge shall apply to each policy period that begins within 3 years from the conviction date of such accident/violation. Forms and Endorsements Form # Date Unit Form # Date Unit Form # Date Unit Form # Date Unit A-10-NH (8/13) ALL IL P 001 (1/04) ALL SIG-1 (1/12) ALL Policy Interests ISG W Issued Date: 04/21/2013 AGENT ONLINE COPY Page 2 of 2

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76 SERFF Tracking #: OHMG State Tracking #: 07/17/2013 FJC Company Tracking #: 2013 AMSNH FORMS State: New Hampshire Filing Company: United Ohio Insurance Company TOI/Sub-TOI: 19.0 Personal Auto/ Private Passenger Auto (PPA) Product Name: Personal Automobile Project Name/Number: Introduction of a new AMS product/2013 AMSNH Forms Supporting Document Schedules Satisfied - Item: Filing Memorandum Comments: Attachment(s): AMS Forms Explanatory Memorandum.pdf Item Status: Completed Review Status Date: 07/17/2013 Satisfied - Item: Comments: Attachment(s): Item Status: Status Date: Bypassed - Item: Bypass Reason: Attachment(s): Item Status: Status Date: NH Retaliatory Fees The appropriate Retaliatory Filing Fees will be submitted via EFT. Underwriting Guidelines-Personal Lines Rate Filings Not Applicable as this is a Forms Filing PDF Pipeline for SERFF Tracking Number OHMG Generated 11/08/ :34 AM

77 More than a promise Hopley Avenue, P.O. Box 111 Bucyrus, Ohio omig.com June 11, 2013 Honorable Roger A. Sevigny Insurance Commissioner NH Insurance Department 21 South Fruit St., Suite 14 Concord, NH RE: United Ohio Insurance Company (NAIC # 13072) Personal Automobile Filing (New Program) Effective September 16, 2013 New Business Dear Commissioner Sevigny: On behalf of the United Ohio Insurance Company, we are filing the introduction of our Masters Series Personal Automobile product. The new business effective date is September 16, Our United Ohio Insurance Company Masters Series Personal Automobile product is written as a twelve month policy. This filing includes the Policy Wording and Endorsements. The Personal Auto Policy wording (A-10-NH) incorporates the regulatory and statutory requirements from the ISO Amendment of Policy Provisions - New Hampshire, the ISO Uninsured Motorists Coverage New Hampshire, and the ISO Single Uninsured Motorists Coverage New Hampshire. Included in our endorsements is form CEF-286-NH which is used for signatures when a Named Driver Exclusion, A-101-NH, is placed on a policy. The A-101-NH is a static form, so the CEF-286-NH is used in coordination with the A-101-NH for signatures for the Named Driver Exclusion. If you have any questions or concerns, please contact me at or at smichener@omig.com. Thank you for your consideration. Sincerely, Sandra (Sam) Michener Personal Auto Product Manager Product Management Passionate Innovative Partnership