MASSACHUSETTS 2011 GROUP MARKETING NEW/RENEWAL AFFIDAVIT
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1 MASSACHUSETTS 2011 GROUP MARKETING NEW/RENEWAL AFFIDAVIT Attached is the documentation required for the application for the listed Liberty Mutual Group 2011 Group Marketing clients. We have verified that it is the intention of each of the following clients to participate in the Group Marketing program within their organization for the year 2011 and have confirmed their participation to them in writing: Axis Technology LLC Bionostics, Inc. Cambridge Credit Counseling Corporation Carousel Industries Inc. Central One Federal Credit Union Chelsea Employees Federal Credit Union Cornerstone Research, Inc. Medica Corporation New England Institute of Technology Alumni Association Schwan s Shared Services, LLC STAG Capital Partners, LLC Terumo Cardiovascular Systems Co. The Pike School Town Of Braintree Town of Norton Town of Sharon You may contact any of our clients to verify information and confirm participation. Kaitlyn C. Faria
2 AUTO (A) PROPOSED TOTAL ELIGIBLE NUMBER OF ORIGINAL EXPERIENCE or HOME RATE EFFECTIVE CU, E,M, NUMBER IN NUMBER IN CURRENT PLAN AGENCY OR MKT. SUBMITTED YES GROUP NAME STREET ADDRESS City STATE ZIP (H) Dev. (%) DATE GROUP TYPE GROUP GROUP INSUREDS DATE REP. OR NO COMMENTS Liberty Mutual Insurance Company Axis Technology LLC 185 Devonshire Place Boston MA A 5% 05/05/11 E /05/11 Joseph Picone NO Liberty Mutual Insurance Company Bionostics, Inc. 7 Jackson Road Devens MA A 5% 05/05/11 E /05/11 Dan Pomfret NO Liberty Mutual Insurance Company Cambridge Credit Counseling Corporation 67 Hunt St. Agawam MA A 5% 05/05/11 E /05/11 Kathryn Daviau NO Liberty Mutual Insurance Company Carousel Industries Inc. 659 South County Trail Exeter RI A 5% 05/05/11 E /05/11 Paul Hackley NO Liberty Mutual Insurance Company Central One Federal Credit Union 714 MAIN ST SHREWSBURY MA A 5% 05/05/11 CU 30,599 18, /05/11 Paul Kiersnowski NO Liberty Mutual Insurance Company Chelsea Employees Federal Credit Union 500 BROADWAY RM 205 CHELSEA MA A 5% 05/05/11 CU 1,973 1, /05/11 Paul Kiersnowski NO Liberty Mutual Insurance Company Cornerstone Research, Inc. 699 Boylston Street, 5th Floor Boston MA A 5% 05/05/11 E /05/11 Chad Frazier NO Liberty Mutual Insurance Company Medica Corporation 5 oak park drive Bedford MA A 5% 05/05/11 E /05/11 Janet Rousseau NO Liberty Mutual Insurance Company New England Institute of Technology Alumni Association 2500 Post Road Warwick RI A 8% 05/05/11 M 34,000 8, /05/11 Paul Hackley NO Liberty Mutual Insurance Company Schwan s Shared Services, LLC 115 West College Drive Marshall MN A 5% 05/05/11 E 17, /05/11 Michael Craig NO Liberty Mutual Insurance Company STAG Capital Partners, LLC 99 High Street, 28th Fl Boston MA A 5% 05/05/11 E /05/11 Jill Auxier NO Liberty Mutual Insurance Company Terumo Cardiovascular Systems Co Jackson Road Ann Arbor MI A 5% 05/05/11 E /05/11 Jerry Gindele NO Liberty Mutual Insurance Company The Pike School 34 Sunset Rock Road Andover MA A 8% 05/05/11 E /05/11 Stephen Bowen NO Liberty Mutual Insurance Company Town Of Braintree 1 JFK Memorial Drive Braintree MA A 5% 05/05/11 E /05/11 Michael Stuart NO Liberty Mutual Insurance Company Town of Norton 70 East Main Street Norton MA A 8% 05/05/11 E /05/11 Nina Schwitters NO Liberty Mutual Insurance Company Town of Sharon 90 South Main ST Sharon MA A 5% 05/05/11 E 1,200 1, /05/11 Paul Hackley NO LM Response Page 1
3 2011 EXPENSE EXHIBIT FOR ALL 193R GROUP MARKETING PLANS Insurers are required to submit the expense ratios underlying their current rates and the expense ratio or average expense per vehicle associated with the group marketing plan (1) (2) (3) (4) Expenses Assumed Expenses Associated Reasons for Requested INSURANCE In Insurer's Rates With Group Marketing Expensed Group Rate COMPANY GROUPNAME Currently On File* Plan Difference Deviation Liberty Mutual Insurance Company Axis Technology LLC 29.00% Liberty Mutual Insurance Company Bionostics, Inc % Liberty Mutual Insurance Company Cambridge Credit Counseling Corporation 29.00% Liberty Mutual Insurance Company Carousel Industries Inc % Liberty Mutual Insurance Company Central One Federal Credit Union 29.00% Liberty Mutual Insurance Company Chelsea Employees Federal Credit Union 29.00% Liberty Mutual Insurance Company Cornerstone Research, Inc % Liberty Mutual Insurance Company Medica Corporation 29.00% Liberty Mutual Insurance Company New England Institute of Technology Alumni Association 29.00% Liberty Mutual Insurance Company Schwan s Shared Services, LLC 29.00% Liberty Mutual Insurance Company STAG Capital Partners, LLC 29.00% Liberty Mutual Insurance Company Terumo Cardiovascular Systems Co % Liberty Mutual Insurance Company The Pike School 29.00% Liberty Mutual Insurance Company Town Of Braintree 29.00% Liberty Mutual Insurance Company Town of Norton 29.00% Liberty Mutual Insurance Company Town of Sharon 29.00% * Expense ratio shown for non group business
4 AUT NUMBE ELIGIBL R OF EXPERIEN O (A) PROPOSE TOTAL E CURREN CE or D NUMBE NUMBE T ORIGINAL SUBMITTE HOM RATE Dev. EFFECTI CU, E,M, R IN R IN INSURE PLAN AGENCY OR MKT. D YES OR GROUP NAME STREET ADDRESS City STATE ZIP E (H) (%) VE DATE GROUP TYPE GROUP GROUP DS DATE REP. NO COMMENTS Axis Technology LLC 185 Devonshire Place Boston MA A E Joseph Liberty Mutual Insurance Company % Picone NO Liberty Mutual Insurance Company Bionostics, Inc. 7 Jackson Road Devens MA A 5% E Dan Pomfret NO Liberty Mutual Insurance Company Cambridge Credit Counseling Corporation 67 Hunt St. Agawam MA A 5% E Kathryn Daviau NO Liberty Mutual Insurance Company Carousel Industries Inc. 659 South County Trail Exeter RI A 5% E Paul Hackley NO Liberty Mutual Insurance Company Central One Federal Credit Union 714 MAIN ST SHREWSBURY MA A 5% CU 30,599 18,848 Paul Kiersnowski NO Liberty Mutual Insurance Company Chelsea Employees Federal Credit Union 500 BROADWAY RM 205 CHELSEA MA A 5% CU 1,973 1,443 Paul Kiersnowski NO Liberty Mutual Insurance Company Cornerstone Research, Inc. 699 Boylston Street, 5th Floor Boston MA A 5% E Chad Frazier NO Liberty Mutual Insurance Company Medica Corporation 5 oak park drive Bedford MA A 5% E Janet Rousseau NO Liberty Mutual Insurance Company New England Institute of Technology Alumni Association 2500 Post Road Warwick RI A 8% M 34,000 8,000 Paul Hackley NO Liberty Mutual Insurance Company Schwan s Shared Services, LLC 115 West College Drive Marshall MN A 5% E 17, Michael Craig NO Liberty Mutual Insurance Company STAG Capital Partners, LLC 99 High Street, 28th Fl Boston MA A 5% E Jill Auxier NO Liberty Mutual Insurance Company Terumo Cardiovascular Systems Co Jackson Road Ann Arbor MI A 5% E Jerry Gindele NO Liberty Mutual Insurance Company The Pike School 34 Sunset Rock Road Andover MA A 8% E Stephen Bowen NO Liberty Mutual Insurance Company Town Of Braintree 1 JFK Memorial Drive Braintree MA A 5% E Michael Stuart NO Liberty Mutual Insurance Company Town of Norton 70 East Main Street Norton MA A 5% E Nina Schwitters NO Liberty Mutual Insurance Company Town of Sharon 90 South Main ST Sharon MA A 5% E 1,200 1,200 Paul Hackley NO LM Response Page 1
5 2011 EXPENSE EXHIBIT FOR ALL 193R GROUP MARKETING PLANS Insurers are required to submit the expense ratios underlying their current rates and the expense ratio or average expense per vehicle associated with the group marketing plan (1) (2) (3) (4) Expenses Assumed Expenses Associated Reasons for Requested INSURANCE In Insurer's Rates With Group Marketing Expensed Group Rate COMPANY GROUPNAME Currently On File* Plan Difference Deviation Liberty Mutual Insurance Company Axis Technology LLC 29.00% Liberty Mutual Insurance Company Bionostics, Inc % Liberty Mutual Insurance Company Cambridge Credit Counseling Corporation 29.00% Liberty Mutual Insurance Company Carousel Industries Inc % Liberty Mutual Insurance Company Central One Federal Credit Union 29.00% Liberty Mutual Insurance Company Chelsea Employees Federal Credit Union 29.00% Liberty Mutual Insurance Company Cornerstone Research, Inc % Liberty Mutual Insurance Company Medica Corporation 29.00% Liberty Mutual Insurance Company New England Institute of Technology Alumni Association 29.00% Liberty Mutual Insurance Company Schwan s Shared Services, LLC 29.00% Liberty Mutual Insurance Company STAG Capital Partners, LLC 29.00% Liberty Mutual Insurance Company Terumo Cardiovascular Systems Co % Liberty Mutual Insurance Company The Pike School 29.00% Liberty Mutual Insurance Company Town Of Braintree 29.00% Liberty Mutual Insurance Company Town of Norton 29.00% Liberty Mutual Insurance Company Town of Sharon 29.00% * Expense ratio shown for non group business
ELIGIBL. EXPERIEN CE or AUT O (A) PROPOSE TOTAL SUBMITTE. LM Response NO COMMENTS. GROUP NAME STREET ADDRESS City STATE ZIP
AUT O (A) PROPOSE TOTAL ELIGIBL E PROPOS PROPOSE EXPERIEN CE or D NUMBE NUMBE ED D SUBMITTE HOM RATE Dev. EFFECTI CU, E,M, R IN R IN EFFECTI EFFECTIV AGENCY OR MKT. D YES OR GROUP NAME STREET ADDRESS City
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AUTO (A) PROPOSED TOTAL ELIGIBLE NUMBER OF ORIGINAL EXPERIENCE or HOME RATE Dev. EFFECTIVE CU, E,M, NUMBER IN NUMBER IN CURRENT PLAN AGENCY OR MKT. SUBMITTED GROUP NAME STREET ADDRESS City STATE ZIP (H)
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