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1 Transmittal Header USPH-6KHRMQ423/00-00/00-00/00 Transmittal Header USPH-6KHRMQ423/00-00/00-00/00 Sent: 12/28/ :20:21 PM CST Created by: Carolyn M Honza Other Authors: None Assigned To: Helen Best TOI: 010 Property Public Access: No Sub TOI: Commercial Property Company List: Federated Mutual Insurance Company Federated Service Insurance Company Filing Information: Filing Action: Initial Filing Date: 12/28/2005 State: North Carolina State Instance ID: PC State Domain: None Filing Type: Forms & Form Rules TOI: 010 Property Sub TOI: Commercial Property Product Name: Commercial Property/CP (Forms) Implementation Date Effective Date Requested: None Requested: 07/01/2006 Project Name: Filing Machine Shop and Project #: CP (Forms) Business Income form changes Fee Required: No Fee Amount: $000 Check Number: None Check Amount: $000 Check Received: None Reference Filing: No Reference Org: None Reference #: None Advisory Org Circular #: None Tracking Information: Company Tracking #: None State Tracking #: PC PC Company Status: None State Status: Assigned Date Company Status Changed: None Date State Status Changed: 12/29/2005 SERFF Tracking #: USPH-6KHRMQ423/00 Delivery Date: 12/28/ :20:23 PM CST SERFF Status: Arrived at State Disposition Date: None Date SERFF Implementation Date: None Status Changed: 12/28/2005 Deemer Date: None Effective Date: None Reviewers: Helen Best State-Specific Fields: No state-specific fields present for this State

2 Transmittal Header USPH-6KHRMQ423/00-00/00-00/00 Company Contact: Lead Company: Federated Mutual Insurance Company Filing Company Info Contact Info Federated Mutual Insurance Company 121 East Park Square, PO Box 328, Owatonna, MN USA Phone: (800) Fax: (507) Cocode: Group Code: 007 FEIN: State of Domicile: Minnesota State ID #: None Carolyn Honza Property & Casualty Product Specialist Federated Mutual Insurance Company 121 E Park Square, PO Box 328, Owatonna, MN Phone: (800) ext 8032 Fax: (507) cmhonza@fedinscom Federated Service Insurance Company 121 East Park Square, PO Box 328, Owatonna, MN USA Phone: (800) Fax: None Cocode: Group Code: 007 FEIN: State of Domicile: Minnesota State ID #: None Carolyn Honza Property & Casualty Product Specialist Federated Mutual Insurance Company 121 E Park Square, PO Box 328, Owatonna, MN Phone: (800) ext 8032 Fax: (507) cmhonza@fedinscom Submission Requirements: Status Requirement Satisfied NAIC PC Uniform Transmittal Document Satisfied Form Filing Questionnaire FC-048 Satisfied Cover Letter - Property and Casualty Components sent originally with filing: USPH-6KHRMQ423/00-01/00-00/00 USPH-6KHRMQ423/00-02/00-00/00 USPH-6KHRMQ423/00-03/00-00/00 USPH-6KHRMQ423/00-04/00-00/00 USPH-6KHRMQ423/00-05/00-00/00 Additional State Tracking Numbers: Federated Mutual Insurance Company Federated Service Insurance Company PC PC PC PC Reopened Filing History: None Filing Description: We would like this filing to be applicable to all policies effective on or after July 1, 2006 File Attachments: None

3 Component Header USPH-6KHRMQ423/00-01/00-00/00 Component Header Component 01 - Rev 00 Sent: 12/28/ :20:21 PM CST Created by: Carolyn M Honza Other Authors: None Assigned To: Helen Best TOI: 010 Property Company List: Federated Mutual Insurance Company Federated Service Insurance Company Sub TOI: Commercial Property Tracking Information: State: North Carolina State Tracking #: PC PC SERFF Tracking #: USPH-6KHRMQ423/00-01/00-00/00 Component Status (State): Assigned Component Status (SERFF): Assigned to Reviewer Disposition Date: None Delivery Date: 12/28/ :20:24 PM CST Implementation Date: None Reviewers: Helen Best Deemer Date: None Reviewer Phone: None Effective Date: None Reviewer Fax: None Requirement Status: Satisfied Primary Reviewer: Helen Best Component Information: Component Type: Form Component Action: Initial Lead Form Number: None State Specific Code: None Form Title: None Company Form Number: None Readability Score: None Replaces Form Number: None Requirement Satisfied: NAIC PC Uniform Transmittal Document Brief Description: Filing Machine Shop and Business Income forms changes Filer's Notes: None Company Contact: Lead Company: Federated Mutual Insurance Company Company Information Federated Mutual Insurance Company Federated Service Insurance Company Contact Carolyn Honza Carolyn Honza File Attachments: NAIC P & CTransmittal Document PC TD-1 pages 1&2 _forms_pdf NAIC P & C Transmittal Document PC FFS-1_Form_ page 3pdf

4 Property & Casualty Transmittal Document 1 Reserved for Insurance Dept Use Only 2 Insurance Department Use only a Date the filing is received: b Analyst: c Disposition: d Date of disposition of the filing: e Effective date of filing: f State Filing #: g SERFF Filing #: 3 Group Name Group NAIC # Federated Insurance Companies Company Name(s) Domicile NAIC # FEIN # Federated Mutual Insurance Company MN Federated Service Insurance Company MN Company Tracking Number CP (forms) Contact Info of Filer(s) or Corporate Officer(s) [include toll-free number] 6 Name and address Title Telephone #s FAX # Carolyn Honza 121 E Park Sq P & C Product Specialist Cmhonza@fedinscom 7 Signature of authorized filer 8 Please print name of authorized filer Carolyn Honza Filing information (see General Instructions for descriptions of these fields) 9 Type of Insurance (TOI) Div 5 Fire & Allied Lines 10 Sub-Type of Insurance (Sub-TOI) Commercial Property 11 State Specific Product code(s)(if applicable)[see State Specific Requirements] NA 12 Company Program Title (Marketing title) 13 Filing Type [ ] Rate/Loss Cost [ ] Rules [ ] Rates/Rules [ ] Forms [ ] Combination Rates/Rules/Forms [ ] Withdrawal[ ] Other (give description) 14 Effective Date(s) Requested New: Renewal: Reference Filing? [ ] Yes No 16 Reference Organization (if applicable) 17 Reference Organization # & Title 18 Company s Date of Filing December 28, Status of filing in domicile [ ] Not Filed [ ] Pending ] Authorized [ ] Disapproved PC TD-1 pg 1 of 2

5 Property & Casualty Transmittal Document 20 This filing transmittal is part of Company Tracking # CP (forms) 21 Filing Description [This area should be similar to the body of a cover letter and is free-form text] Filing Machine Shop and Business Income changes 22 Filing Fees (Filer must provide check # and fee amount if applicable) [If a state requires you to show how you calculated your filing fees, place that calculation below] Check #: NA Amount: Refer to each state s checklist for additional state specific requirements or instructions on calculating fees ***Refer to the each state s checklist for additional state specific requirements (ie # of additional copies required, other state specific forms, etc) PC TD-1 pg 2 of 2

6 FORM FILING SCHEDULE (This form must be provided ONLY when making a filing that includes forms) (Do not refer to the body of the filing for the forms listing) 1 This filing transmittal is part of Company Tracking # CP (forms) This filing corresponds to rate/rule filing number (Company tracking number of rate/rule filing, if applicable) Form Name /Description/Synopsis Business Income Motor Vehicle Dealers Amendment Endorsement Business Income Special Form Premier Select Property Amendatory Endorsement Machine Shop Property Coverage Extension (Machine Pac) Machine Shop Operations Damage to Work in Progress Business Income Coverage Form (No Coinsurance Form) Business Income Amendatory Endorsement Form # Include edition date CP-F-23 (11-05) CP-F-36 (11-05) CP-F-113 (11-05) CP-F-117 (11-05) CP-F-126 (11-05) CP-F-20 (06-88) CP-F-103 (12-00) Replacement Or withdrawn? [ ] Replacement [ ] Withdrawn [ ] Neither [ ] Replacement [ ] Withdrawn [ ] Neither [ ] Replacement [ ] Withdrawn [ ] Neither [ ] Replacement [ ] Withdrawn [ ] Neither [ ] Replacement [ ] Withdrawn [ ] Neither [ ] Replacement [ ] Withdrawn [ ] Neither [ ] Replacement [ ] Withdrawn [ ] Neither [ ] Replacement [ ] Withdrawn [ ] Neither CP (rules) If replacement, give form # it replaces CP-F-23 (06-99) CP-F-36 (06-99) CP-F-113 (10-04) CP-F-117 (10-04) Previous state filing number, if required by state To be complete, a form filing must include the following: 1 A completed Form Filing Schedule Document (PC FFS-1) (Do not refer to the body of the filing for the forms listing) and, 2 A completed Property & Casualty Transmittal Document (PC TD-1), and 3 One copy of each form to be reviewed for the reviewer s records, and 4 One copy of any other components/exhibits submitted with the filing, and 5 The appropriate state Review Requirements, if required, and 6 The appropriate filing fees, if required, and 7 A postage-paid, self-addressed envelope large enough to accommodate the return 8 You should refer to the each state s checklist for additional state specific requirements (ie # of additional copies required, other state specific forms, etc) PC FFS-1

7 Component Header USPH-6KHRMQ423/00-02/00-00/00 Component Header Component 02 - Rev 00 Sent: 12/28/ :20:21 PM CST Created by: Carolyn M Honza Other Authors: None Assigned To: Helen Best TOI: 010 Property Company List: Federated Mutual Insurance Company Federated Service Insurance Company Sub TOI: Commercial Property Tracking Information: State: North Carolina State Tracking #: PC PC SERFF Tracking #: USPH-6KHRMQ423/00-02/00-00/00 Component Status (State): Assigned Component Status (SERFF): Assigned to Reviewer Disposition Date: None Delivery Date: 12/28/ :20:23 PM CST Implementation Date: None Reviewers: Helen Best Deemer Date: None Reviewer Phone: None Effective Date: None Reviewer Fax: None Requirement Status: Satisfied Primary Reviewer: Helen Best Component Information: Component Type: Form Component Action: Initial Lead Form Number: None State Specific Code: None Form Title: None Company Form Number: None Readability Score: None Replaces Form Number: None Requirement Satisfied: Form Filing Questionnaire FC-048 Brief Description: Filing Machine Shop and Business Income forms changes Filer's Notes: None Company Contact: Lead Company: Federated Mutual Insurance Company Company Information Federated Mutual Insurance Company Federated Service Insurance Company Contact Carolyn Honza Carolyn Honza File Attachments: FC-048 _05-98_ NC Forms Questionnairepdf

8 NORTH CAROLINA DEPARTMENT OF INSURANCE FORM(S) QUESTIONNAIRE (1) NAME OF FILING ORGANIZATION Federated Mutual Ins Co/Federated Service Ins Co (2) FED EMP # (M)/ (S) (3) FILER S FILE # CP (Forms) (4) PROGRAM TITLE Commercial Property (5) LINE(S) OF INSURANCE 10, 21 (6) HOW MANY NEW FORMS AND/OR REVISED FORMS ARE BEING FILED: *NEW 1 *REVISED 4 *Attach forms index, including form numbers, edition dates and titles (7) LIST ALL OLD FORM(S) BEING WITHDRAWN AND DEPARTMENT FILE NUMBER CP-F-20 (06-88) Dept File No not available due to retention CP-F-103 (12-00) PC PC (8) EXPLAIN THE PURPOSE(S) OF THIS FILING (ATTACH SEPARATE LETTER) (9) LIST THE STATES WHERE THIS FILING HAS BEEN MADE: AL, CT, DE, FL, GA, LA, MA, MD, ME, MS, NC, NH, SC, TX, VA (10) HAS THIS FILING BEEN MADE IN YOUR DOMICILIARY STATE? X YES NO IF FILED, WHAT ACTION DID YOUR DOMICILIARY STATE TAKE? Minnesota is No File (11) LIST THE STATES THAT HAVE APPROVED THIS FILING All pending FC-048 (05/7/98)

9 (12) LIST THE STATES THAT HAVE DISAPPROVED THIS FILING AND REASON(S) FOR DISAPPROVAL (ATTACH SEPARATE SHEET) NA (13) ATTACH COPIES OF ALL REQUIRED MODIFICATIONS REFERRED TO IN (11) ABOVE (14) IF THE FILING IS SIMILAR OR IDENTICAL TO A FILING MADE WITH THE NC DEPARTMENT OF INSURANCE BY A LICENSED BUREAU OR LICENSED RATING ORGANIZATION, COMPLETE THE FOLLOWING: (A) NAME OF AFFILIATED BUREAU OR RATING ORGANIZATION (B) NAME OF BUREAU OR RATING ORGANIZATION PROGRAM (C) IDENTIFICATION NUMBER OF BUREAU OR RATING ORGANIZATION PROGRAM (D) ARE YOU A MEMBER ; SUBSCRIBER ; SERVICE PURCHASER (15) IF THE FILING IS SIMILAR OR IDENTICAL TO A FILING MADE WITH THE NC DEPARTMENT OF INSURANCE BY A LICENSED INSURANCE COMPANY IN NORTH CAROLINA, GIVE THE NC INSURANCE DEPARTMENT FILE NUMBER AND APPROVAL DATE FILE # APPROVAL DATE ON A SEPARATE SHEET, DESCRIBE THE DIFFERENCE(S), IF ANY, BETWEEN YOUR FORM(S) AND THOSE OF THE PREVIOUSLY APPROVED PROGRAM (16) COMPUTER PRINTED DECLARATIONS PAGES SHOULD BE COMPLETED IN JOHN DOE FASHION AND ATTACHED (17) PROPOSED EFFECTIVE DATE AND RULE OF IMPLEMENTATION (18) I CERTIFY THAT THE INFORMATION CONTAINED IN THIS QUESTIONNAIRE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE SIGNATURE OF OFFICER OF THE COMPANY OR HEAD OF THE FILINGS DEPARTMENT FC-048 (05/7/98)

10 Component Header USPH-6KHRMQ423/00-03/00-00/00 Component Header Component 03 - Rev 00 Sent: 12/28/ :20:21 PM CST Created by: Carolyn M Honza Other Authors: None Assigned To: Helen Best TOI: 010 Property Company List: Federated Mutual Insurance Company Federated Service Insurance Company Sub TOI: Commercial Property Tracking Information: State: North Carolina State Tracking #: PC PC SERFF Tracking #: USPH-6KHRMQ423/00-03/00-00/00 Component Status (State): Assigned Component Status (SERFF): Assigned to Reviewer Disposition Date: None Delivery Date: 12/28/ :20:24 PM CST Implementation Date: None Reviewers: Helen Best Deemer Date: None Reviewer Phone: None Effective Date: None Reviewer Fax: None Requirement Status: Satisfied Primary Reviewer: Helen Best Component Information: Component Type: Form Component Action: Initial Lead Form Number: None State Specific Code: None Form Title: None Company Form Number: None Readability Score: None Replaces Form Number: None Requirement Satisfied: Cover Letter - Property and Casualty Brief Description: Filing Machine Shop and Business Income forms changes Filer's Notes: None Company Contact: Lead Company: Federated Mutual Insurance Company Company Information Federated Mutual Insurance Company Federated Service Insurance Company Contact Carolyn Honza Carolyn Honza File Attachments: Cover Letter _Forms_pdf

11 December 28, 2005 North Carolina State Insurance Department FEDERATED MUTUAL INSURANCE COMPANY NAIC # FEDERATED SERVICE INSURANCE COMPANY NAIC # COMMERCIAL LINES MANUAL DIVISION FIVE FIRE and ALLIED LINES Federated Forms and Endorsements (See Explanatory Memorandum Attached) Filing # CP (Forms) We submit for your approval the above listed filing Please refer to the Explanatory Memorandum attached for additional details We would like this filing to be applicable to all policies effective on or after July 1, 2006 A related rules filing has been submitted for the same effective date as this forms filing We trust that our filing meets your requirements and we appreciate your consideration of our filing Thank you, Property & Casualty Product Specialist Federated Mutual Insurance Company Federated Service Insurance Company

12 Component Header USPH-6KHRMQ423/00-04/00-00/00 Component Header Component 04 - Rev 00 Sent: 12/28/ :20:21 PM CST Created by: Carolyn M Honza Other Authors: None Assigned To: Helen Best TOI: 010 Property Company List: Federated Mutual Insurance Company Federated Service Insurance Company Sub TOI: Commercial Property Tracking Information: State: North Carolina State Tracking #: PC PC SERFF Tracking #: USPH-6KHRMQ423/00-04/00-00/00 Component Status (State): Assigned Component Status (SERFF): Assigned to Reviewer Disposition Date: None Delivery Date: 12/28/ :20:24 PM CST Implementation Date: None Reviewers: Helen Best Deemer Date: None Reviewer Phone: None Effective Date: None Reviewer Fax: None Requirement Status: Satisfied Primary Reviewer: Helen Best Component Information: Component Type: Form Component Action: Initial Lead Form Number: None State Specific Code: None Form Title: None Company Form Number: None Readability Score: None Replaces Form Number: None Requirement Satisfied: N/A Brief Description: Explanatory--Filing Machine Shop and Business Income forms changes Filer's Notes: None Company Contact: Lead Company: Federated Mutual Insurance Company Company Information Federated Mutual Insurance Company Federated Service Insurance Company Contact Carolyn Honza Carolyn Honza File Attachments: EXPLAN MEMO machine - bi 2005 forms _AL, CT, DE, GA, MA, Mpdf

13 EXPLANATORY MEMORANDUM FORMS Business Income Motor Vehicle Dealers Amendment Endorsement, CP-F-23 (11-05)_ Paragraph reference has been revised to correspond with the Business Income Special Form Premier Select form Business Income Special Form Premier Select, CP-F-36 Editorial changes have been made using current ISO language Additional Limitation Interruption of Computer Operations and Additional Coverage Interruption of Computer Operations has been added Wording is ISO language used in the CP Business Income (And Extra Expense) Coverage Form Period of restoration is revised to begin 72 hours after the time of direct physical loss or damage for business income coverage Civil Authority coverage is revised to begin 72 hours after the time of action begins Also, the described premises must be within a one mile radius of the damaged premises for Civil Authority to apply Information added clarifying that is a loss or damage is caused by windstorm, any business income or extra expense coverage provided by another form or endorsement on the policy will apply first and prior to any coverage being provided under this form Property Amendatory Endorsement, CP-113 Underground property limit increased form $25,000 to $50,000 Machine Shop Property Coverage Extension (Machine Pac), CP-F-117 Off-Premises Services Time Element coverage has been deleted Loss Of Business Income Dependent Properties has been increased from $10,000 to $100,000 Machine Shop Operations Damage To Work In Process CP-F-126 This endorsement will apply to all machine shop types of business that also purchase a Business E & O Policy Coverage applies to personal property owned by the insured or for which they are liable arising out of machine shop operations that is caused by the insureds faulty, inadequate or defective design, specification or workmanship, or material used by the insured in their operation We will pay the least of actual cash value of damaged personal property, cost to correct damaged personal property, or cost to repair the damaged personal property $25,000 will be paid per loss occurrence Regardless of the number of occurrences during the policy period, the most that will be paid is $25,000 per policy period Applicable deductible or $1,000 whichever is greater, will be deducted from each loss Obsolete Forms Business Income Coverage Form (No Coinsurance Form), CP-F-20 This coverage is no longer written Business Income Amendatory Endorsement, CP-F-103 This form is no longer needed, as information has been added to endorsement, CP-F-36, Business Income Special Form Premier Select

14 Component Header USPH-6KHRMQ423/00-05/00-00/00 Component Header Component 05 - Rev 00 Sent: 12/28/ :20:21 PM CST Created by: Carolyn M Honza Other Authors: None Assigned To: Helen Best TOI: 010 Property Company List: Federated Mutual Insurance Company Federated Service Insurance Company Sub TOI: Commercial Property Tracking Information: State: North Carolina State Tracking #: PC PC SERFF Tracking #: USPH-6KHRMQ423/00-05/00-00/00 Component Status (State): Assigned Component Status (SERFF): Assigned to Reviewer Disposition Date: None Delivery Date: 12/28/ :20:27 PM CST Implementation Date: None Reviewers: Helen Best Deemer Date: None Reviewer Phone: None Effective Date: None Reviewer Fax: None Requirement Status: Satisfied Primary Reviewer: Helen Best Component Information: Component Type: Form Component Action: Initial Lead Form Number: None State Specific Code: None Form Title: None Company Form Number: None Readability Score: None Replaces Form Number: None Requirement Satisfied: N/A Brief Description: Forms--Filing Machine Shop and Business Income forms changes Filer's Notes: None Company Contact: Lead Company: Federated Mutual Insurance Company Company Information Federated Mutual Insurance Company Federated Service Insurance Company Contact Carolyn Honza Carolyn Honza File Attachments: CP-F-23 (11-05)PDF CP-F-36 (11-05)PDF CP-F-113 (11-05)PDF CP-F-117 (11-05)PDF CP-F-126 (11-05)PDF

Created by SERFF on :56 PM

Created by SERFF on :56 PM Created by SERFF on 04-16-2007 02:56 PM Filing at a Glance Company: Graphic Arts Mutual Insurance Company Product Name: Homeowners SERFF Tr Num: UTCX-125150909 State: North CarolinaPC TOI: 04.0 Homeowners