SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP

Transcription

1 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: Product Name: Filing at a Glance Company: Main Street America Assurance Company Product Name: Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage State: TOI: Sub-TOI: Filing Type: Massachusetts 05.0 CMP Liability and Non-Liability Businessowners Form Date Submitted: 06/22/2012 SERFF Tr Num: SERFF Status: State Tr Num: State Status: NGMC Closed-Placed on File Closed-Placed On File Co Tr Num: MSAA BOP Effective Date Requested (New): Effective Date Requested (Renewal): Author(s): Reviewer(s): 10/01/ /01/2012 Eileen Kuharich, Nancy Murdough, Nancy Palmisano, Susan Fastenberg, Miranda Doyle, Hollie Carter, Amber May Daniel Smith (primary) Disposition Date: 07/13/2012 Disposition Status: 05.0 CMP Liability and Non-Liability/ Businessowners Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts- Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Placed on File Effective Date (New): 10/01/2012 Effective Date (Renewal): 10/01/2012 PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

2 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: Product Name: 05.0 CMP Liability and Non-Liability/ Businessowners Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts- Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ General Information Project Name: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage Project Number: Reference Organization: Reference Title: Filing Status Changed: 07/13/2012 State Status Changed: 07/13/2012 Created By: Miranda Doyle Corresponding Filing Tracking Number: Status of Filing in Domicile: Not Filed Domicile Status Comments: Reference Number: Advisory Org. Circular: Deemer Date: Submitted By: Miranda Doyle Filing Description: Re: Main Street America Assurance Company Mainline Businessowners Form Filing- BPM 3111 MA (06/12)- Massachusetts-Garagekeepers Broad Coverage MSAA NAIC Number: Company File Number: MSAA BOP The Main Street America Assurance Company (MSAA) is proposing finished form BPM 3111 MA (06/12)-Garagekeepers Broad Coverage in response to DOI Bulletin concerning the determination of Actual Cash Value for the Main Line Businessowners Policy. This form replaces form BPM 3111 (12/07)-Garagekeepers Broad Coverage approved January 7, 2009 under SERFF Tracking #: NGMC MSAA utilizes the Declarations Page to include the Company name for all policies. The form number is BPM D , Businessowners Common Policy Declaration, placed on file under SERFF Tracking Number NGMC This revision is applicable to all New Business policies and all Renewal Policies on or after October 1, Please find Finished Form: BPM 3111 MA (06/12) is attached in the Forms Schedule Tab. Company and Contact Filing Contact Information Nancy Palmisano, State Filings Manager 4601 Touchton Rd East Suite 3400 Jacksonville, FL Filing Company Information Main Street America Assurance Company 4601 Touchton Road East PO Box 16000, Suite 3400 Jacksonville, FL (800) ext. 225[Phone] palmisan@msagroup.com [Phone] 351 [Ext] [FAX] CoCode: Group Code: 311 Group Name: FEIN Number: State of Domicile: Florida Company Type: Property and Casualty State ID Number: PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

3 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: Product Name: Filing Fees Fee Required? State Specific Yes Fee Amount: $75.00 Retaliatory? Fee Explanation: Per Company: 05.0 CMP Liability and Non-Liability/ Businessowners Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts- Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ No Florida has no retaliatory filing fee therefore we use Massachusetts required filing fee. 1 form filing for MSAA= $75.00 filing fee Yes Company Amount Date Processed Transaction # Main Street America Assurance Company $ /22/ ) All Lines: Please see the State Submissions List requirement under Supporting Documentation.: Acknowledge Completion 2.) Property/Casualty: Please see the Policy Endorsement List requirement under Supporting Documentation.: Acknowledge Completion 3.) Property/Casualty: Please see Comment C.5 in the Massachusetts General Instructions.: Not Applicable- this filing is not a delay adopt or non-adopt filing 4.) Life: Please see the Specific Markets requirement under Supporting Documentation.: Not Applicable- this is a Property and Casualty Filing PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

4 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: 05.0 CMP Liability and Non-Liability/ Businessowners Product Name: Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Correspondence Summary Dispositions Status Created By Created On Date Submitted Placed on File Daniel Smith 07/13/ /13/2012 Objection Letters and Response Letters Objection Letters Response Letters Status Created By Created On Date Submitted Responded By Created On Date Submitted Incomplete Daniel Smith 06/22/ /22/2012 Miranda Doyle 07/02/ /02/2012 Filing Notes Subject Note Type Created By Created On Date Submitted Re: Rule Filing Note To Filer Daniel Smith 06/28/ /28/2012 Response to Daniel Smith Note to Filer - sent 6/28/2012 Note To Reviewer Hollie Carter 06/28/ /28/2012 Re: Phone Message Note To Filer Daniel Smith 06/28/ /28/2012 PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

5 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: 05.0 CMP Liability and Non-Liability/ Businessowners Product Name: Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Disposition Disposition Date: 07/13/2012 Effective Date (New): 10/01/2012 Effective Date (Renewal): 10/01/2012 Status: Placed on File Comment: Rate data does NOT apply to filing. Schedule Schedule Item Schedule Item Status Public Access Supporting Document State Submissions List Yes Supporting Document Policy Endorsement List Yes Supporting Document Annotated Comparison Yes Supporting Document Form Utilization List Yes Supporting Document Certification of Compliance Yes Supporting Document (revised) Checklist(s) Yes Supporting Document Checklist(s) Yes Supporting Document Statement of Variability Yes Supporting Document Letter of Authorization Yes Supporting Document Form Explanatory Memorandum Yes Form Massachusetts-Garagekeepers Broad Coverage Yes PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

6 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: Product Name: Objection Letter Objection Letter Status Incomplete Objection Letter Date 06/22/2012 Submitted Date 06/22/2012 Respond By Date 07/02/2012 Dear Nancy Palmisano, Introduction: This filing submission is incomplete. Please respond to the following objections in accordance with SERFF procedures for responding to an Objection Letter: Objection 1 Comments: Please advise when the rating rules governing the premium charge for the submitted endorsement were place don file by the Division, and provide the SERFF tracking number. Objection 2 - Checklist(s) (Supporting Document) Comments: Please complete and submit the current edition. Conclusion: 05.0 CMP Liability and Non-Liability/ Businessowners Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts- Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Upon receipt of your response, this filing will be scheduled for review. This filing will be closed for lack of action if a response is not received on or before 4:30 PM EDT on the Respond By Date indicated in this Objection Letter. Should you decide to withdraw this filing, please notify us via response to this objection. Thank you. Sincerely, Daniel Smith PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

7 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: 05.0 CMP Liability and Non-Liability/ Businessowners Product Name: Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Response Letter Response Letter Status Submitted to State Response Letter Date 07/02/2012 Submitted Date 07/02/2012 Dear Daniel Smith, Introduction: In response to your objections dated June 22nd, 2012 Main Street America Assurance Company (MSAA) has provided a Revised Property and Casualty Checklist attached under the Supporting Documentation tab. Response 1 Comments: Main Street America Assurance Company (MSAA) will file a rule on the state specific exception page MA-EX-5 to correspond with the replacement form BPM 311 MA (06/12)-Massachusetts Garagekeepers Broad Coverage Form by July 6th, Related Objection 1 Comments: Please advise when the rating rules governing the premium charge for the submitted endorsement were place don file by the Division, and provide the SERFF tracking number. Changed Items: No Supporting Documents changed. No Form Schedule items changed. No Rate/Rule Schedule items changed. Response 2 Comments: Main Street America Assurance Company (MSAA) has provided a revised and correct version of the Property and Casualty Checklist under the Supporting Documentation tab. Related Objection 2 Applies To: - Checklist(s) (Supporting Document) Comments: Please complete and submit the current edition. Changed Items: PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

8 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: 05.0 CMP Liability and Non-Liability/ Businessowners Product Name: Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Supporting Document Schedule Item Changes Satisfied -Name: Checklist(s) Comment: Please see the attached Property Casualty Products Checklist. No Form Schedule items changed. No Rate/Rule Schedule items changed. Conclusion: We apologize for any inconvenience. Sincerely, Miranda Doyle, AIS and AINS State Filing Specialist Sincerely, Miranda Doyle PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

9 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: Product Name: Note To Filer Created By: Daniel Smith on 06/28/ :46 AM Last Edited By: Daniel Smith Submitted On: 07/13/ :19 PM Subject: Re: Rule Filing Comments: Ms. Carter, 05.0 CMP Liability and Non-Liability/ Businessowners Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts- Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Thank you for clarifying. If the exception page simply states replacement of the form in your portfolio but does not change the way the cost is calculated, it may be submitted in a Rule filing with no rate requirements. However, if the exception page does include rating rules, we will need a Rate/Rule filing. Thank you. Daniel J. Smith Policy Form Review PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

10 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: Product Name: Note To Reviewer Created By: Hollie Carter on 06/28/ :42 AM Last Edited By: Daniel Smith Submitted On: 07/13/ :19 PM Subject: Response to Daniel Smith Note to Filer - sent 6/28/2012 Comments: Mr. Smith, 05.0 CMP Liability and Non-Liability/ Businessowners Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts- Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ I apologize you were unable to leave a voice message in response to my earlier call. I wanted to clarify that the original Businessowners Garage Keepers Form, BPM 3111, was previously filed and approved with a corresponding rating rule back in January However; with the current filing, we are proposing to replace BPM 3111 with a company/state specific version: BPM 3111-MA. As a result, an exception rule will need to be filed which corresponds to BPM 3111-MA. The rating rule, which will be submitted in a separate companion filing, will be filed with the same proposed effective date as the form: 10/1/2012. As such, the rating methodology for the Garage Keepers Coverage Form has been established, filed and approved via the January 2009 filing. The exception rule we are submitting now, will simply state our intent to replace BPM 3111 with BPM 3111-MA. The content of the rule remains the same. Thank you for your advisement on how to best handle the corresponding rule filing. We will provide the additional details concerning the submission of the companion rule with our objection response. Thank you for your time and attention to this matter. Sincerely, Hollie Carter carterh@msagroup.com PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

11 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: Product Name: Note To Filer Created By: Daniel Smith on 06/28/ :20 AM Last Edited By: Daniel Smith Submitted On: 07/13/ :19 PM Subject: Re: Phone Message Comments: Ms. Carter, 05.0 CMP Liability and Non-Liability/ Businessowners Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts- Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Thank you for your voice message from yesterday afternoon. I called you a few minutes ago, but got your voice mailbox, which seems to be full, so I'm sending you this Note. Your message indicated that the rating rule, which the first objection in my June 22 Letter regards, needs to be developed and submitted. However, this is a filing for a revision to a form that was originally placed on file in January I am not sure I understand how the form would have been placed on file originally without its rating rule, nor how the Filing Company would have been issuing a premium-bearing form without the rule that determines the premium. Nevertheless, if the rating is something that needs to be developed and submitted, it will need to be submitted in a separate Rate/Rule filing as the Filing Type for this filing (Form) cannot be changed. Please note that full Rate filing requirements would apply to the companion filing. Please respond to the objection addressing both points in the paragraph above: why the rating rule doe snot currently exist, and when the companion filing will be submitted. Please note as well that this filing's review will be suspended until the rating rule is submitted, so it may be reviewed with the form. Thank you. Daniel J. Smith Policy Form Review PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

12 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: 05.0 CMP Liability and Non-Liability/ Businessowners Product Name: Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Form Schedule Item Schedule Item Form Form Edition Form Action/ Readability No. Status Name Number Date Type Action Specific Data Score Attachments 1 Massachusetts-Garagekeepers Broad BPM /12 END Replaced: Finished Form Coverage MA Replaced Form #: BPM BPM 3111 MA ( (12/07) 12)- Previous Filing #: NGMC- Massachusetts Garagekeepers Broad Coverage.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 NGMC Generated 07/31/ :28 AM

13 POLICY NUMBER: BUSINESSOWNERS BPM 3111MA 0612 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MASSACHUSETTS - GARAGEKEEPERS BROAD COVERAGE This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SECTION II - LIABILITY With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Location Number Address Where You Conduct Garage Operations (Main Location) Coverages Limit Of Insurance And Deductible Premium Comprehensive $ [$25,000 to $1,000,000] Minus $ $ [$250 to $500.] Deductible For All Perils Subject To $ [$1,250 to $5,000] Maximum Deductible For All Such Loss In Any One Event. Collision $ [$25,000 to $1,000,000] Minus $ [$500. To $1,000] Deductible For Each Customer's Auto. $ Location Number Address Where You Conduct Garage Operations Coverages Limit Of Insurance And Deductible Premium Comprehensive $ [$25,000 to $1,000,000] Minus $ $ [$250 to $500.] Deductible For All Perils Subject To $ [$1,250 to $5,000] Maximum Deductible For All Such Loss In Any One Event. Collision $ [$25,000 to $1,000,000] Minus $ [$500. To $1,000] Deductible For Each Customer's Auto. $ BPM 3111MA 0612 Page 1 of 3

14 Location Number Address Where You Conduct Garage Operations Coverages Limit Of Insurance And Deductible Premium Comprehensive $ [$25,000 to $1,000,000] Minus $ $ [$250 to $500.] Deductible For All Perils Subject To $ [$1,250 to $5,000] Maximum Deductible For All Such Loss In Any One Event. Collision $ [$25,000 to $1,000,000] Minus $ [$500. To $1,000] Deductible For Each Customer's Auto. $ Total Premium For All Locations $ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. COVERAGE OPTIONS Indicated below with an "X" which, if any, Coverage Option is selected. LEGAL LIABILITY If this box is checked, coverage applies on the basis of the insured s legal liability. DIRECT PRIMARY If this box is checked, coverage applies without regard to your or any other "insured's" legal liability for "loss" to a "customer's auto" and is primary insurance. A. This endorsement provides only those coverages: 1. Where a Limit of Insurance and a premium are shown for that coverage in the Schedule; and 2. For the location shown in the Schedule. B. Coverage 1. We will pay all sums the "insured" legally must pay as damages for "loss" to a "customer's auto" or "customer's auto" equipment left in the "insured's" care while the "insured" is attending, servicing, repairing, parking or storing it in your "garage operations" under: a. Comprehensive Coverage From any cause except: (1) The "customer's auto's" collision with another object; or (2) The "customer's auto's" overturn. b. Collision Coverage Caused by: (1) The "customer's auto's" collision with another object; or (2) The "customer's auto's" overturn. 2. We will have the right and duty to defend any "insured" against a "suit" asking for these damages. However, we have no duty to defend any "insured" against a "suit" seeking damages for "loss" to which this insurance does not apply. We may investigate and settle any claim or "suit" as we consider appropriate. Our duty to defend or settle ends for a coverage when the Limit of Insurance for that coverage has been exhausted by payment of judgments or settlements. C. Exclusions 1. This insurance does not apply to any of the following: a. Contractual Obligations Liability resulting from any contract or agreement by which the "insured" accepts responsibility for "loss". But this exclusion does not apply to liability for "loss" that the "insured" would have in the absence of the contract or agreement. Page 2 of 3 BPM 3111MA 0612

15 b. Theft "Loss" due to theft or conversion caused in any way by you, your "employees" or by your shareholders. c. Defective Parts Defective parts or materials. d. Faulty Work Faulty "work you performed". 2. We will not pay for "loss" to any of the following: a. Tapes, records, discs and other sound reproducing devices designed for use with sound reproducing equipment. b. Any device designed or used to detect speed measurement equipment such as radar or laser detectors and any jamming apparatus intended to elude or disrupt speed measurement equipment. 3. We will not pay for "loss" caused by or resulting from the following. Such "loss" is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the "loss": a. War, including undeclared or civil war; b. Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or c. Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. D. Limits Of Insurance And Deductibles 1. Regardless of the number of "customer's autos", "insureds", premiums paid, claims made or "suits" brought, the most we will pay for each "loss" at each location is the Limit of Insurance shown in the Schedule for that location minus the applicable deductibles for "loss" caused by: a. Collision; or b. Comprehensive 2. The maximum deductible stated in the Schedule for Comprehensive Coverage is the most that will be deducted for all "loss" in any one event. 3. Sometimes to settle a claim or "suit", we may pay all or any part of the deductible. If this happens you must reimburse us for the deductible or that portion of the deductible that we paid. E. Conditions The following Conditions apply to Physical Damage Coverage. Actual Cash Value Whenever the appraised cost of repair of an auto plus the probable salvage value of the auto may be reasonably expected to exceed the actual case value of the auto, we shall determine the auto s actual cash value. Our determination shall be based on a consideration of all of the following factors: 1.) The retail book value for an auto of like kind and quality, but for the damage incurred; 2.) The price paid for the auto plus the value of prior improvements to the auto at the time of the accident, less appropriate depreciation; 3.) The decrease in value of the auto resulting from prior unrelated damage which is detected by the appraiser; and 4.) The actual cost of purchase of an available auto of like kind and quality but for the damage sustained. F. Additional Definitions As used in this endorsement: 1. "Customer's auto" means a customer's land motor vehicle or trailer or semitrailer. This definition also includes any customer's auto while left with you for service, repair, storage or safekeeping. Customers include your "employees", and members of their households who pay for services performed. 2. "Loss" means direct and accidental loss or damage and includes any resulting loss of use. 3. "Garage operations" means the ownership, maintenance or use of locations for the purpose of a business of selling, servicing, repairing, parking or storing "customer's autos" and that portion of the roads or other accesses that adjoin these locations. "Garage operations" also includes all operations necessary or incidental to the performance of garage operations. 4. "Work you performed" includes: a. Work that someone performed on your behalf; and b. The providing of or failure to provide warnings or instructions. BPM 3111MA 0612 Page 3 of 3

16 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: 05.0 CMP Liability and Non-Liability/ Businessowners Product Name: Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Supporting Document Schedules Item Status: Status Date: Satisfied - Item: Comments: State Submissions List Please see the attached State Submission List. Please note that the state of Massachusetts is the only state in which the filed materials have been submitted. Attachment(s): State Submission List.pdf Item Status: Status Date: Satisfied - Item: Comments: Policy Endorsement List Please see the attached Policy Endorsement List. Attachment(s): Policy Endorsement List.pdf Item Status: Status Date: Satisfied - Item: Comments: Annotated Comparison Please see the attached Finished Form BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Side-by-Side. Attachment(s): Finished Form BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Side-by-Side.pdf Item Status: Status Date: Satisfied - Item: Comments: Form Utilization List Please see the attached Form Utilization List. Attachment(s): Form Utilization List.pdf Item Status: Status Date: Satisfied - Item: Comments: Certification of Compliance Please see the attached Certification of Compliance. PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

17 SERFF Tracking #: NGMC State Tracking #: Company Tracking #: MSAA BOP State: Massachusetts Filing Company: Main Street America Assurance Company TOI/Sub-TOI: 05.0 CMP Liability and Non-Liability/ Businessowners Product Name: Main Street America Assurance Company- Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)-Massachusetts-Garagekeepers Broad Coverage Project Name/Number: Mainline Businessowners-Form Filing- BPM 3111 MA (06-12)Massachusetts-Garagekeepers Broad Coverage/ Attachment(s): Certification of Compliance.pdf Item Status: Status Date: Satisfied - Item: Comments: Checklist(s) Please see the attached Property Casualty Products Checklist. Attachment(s): Revised Property & Casualty Checklist.pdf Item Status: Status Date: Satisfied - Item: Comments: Statement of Variability Please see the attached Statement of Variability. Attachment(s): Statement of Variability.pdf Item Status: Status Date: Bypassed - Item: Bypass Reason: Letter of Authorization Not Applicable. Comments: Item Status: Status Date: Satisfied - Item: Comments: Form Explanatory Memorandum Please see the attached Form Explanatory Memorandum. Attachment(s): Form Explanatory Memorandum.pdf PDF Pipeline for SERFF Tracking Number NGMC Generated 07/31/ :28 AM

18 RESET FORM MASSACHUSETTS DIVISION OF INSURANCE STATE SUBMISSIONS LIST INSTRUCTIONS: Please indicate the following regarding the materials submitted in this filing: - In the Submitted column, an X for each state in which the materials have been filed; - In the Approved column, an X for each state in which the materials have already been approved; - In the Disapproved column, an X for each state that has disapproved the submitted materials. Please include the reasons for any Disapprovals in the Comment section of the SERFF component. Please note that the Massachusetts Division of Insurance uses this information to help prioritize incoming filings, as well as to highlight areas that may require managerial level review. Mainline Businessowners Policy Please enter the product name as filed. State Submitted Approved Disapproved Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana X State Submitted Approved Disapproved Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington, DC Other Territories PFR-SSL (01/12)

19 RESET FORM MASSACHUSETTS DIVISION OF INSURANCE POLICY ENDORSEMENT LIST INSTRUCTIONS: For filings containing or adopting Endorsements 1, please indicate the following: - In the Endorsement Name column, the name of each Endorsement submitted in the filing; - In the Form Number column, the form number of each Endorsement submitted in the filing; - In the M/O/E, whether each Endorsement is Mandatory 2 (M), Optional 3 (O) or Elected 4 (E); - In the Advise to Applicant/Insured column, how the applicant/insured is advised of the option to elect or decline each Elected Endorsement; - In the Premium/Credit column, whether the Endorsement bears a premium or credit or otherwise impacts the policy rate (Yes/No). All Endorsements must be listed in the program s filed manual/exception pages; the rules for Optional Endorsements must also state the circumstances under which the Filing Company may issue each Endorsement. Mainline Businessowners Policy Please enter the product name as filed. Endorsement Name Form Number M/O/E Advise to Applicant/Insured Premium/Credit Limited Food Spoilage ABC 0671 (07/11) E Advised by agent No Massachusetts - Garagekeepers Broad Coverage BPM 3111MA 0612 E Advised by Agent Yes 1 Endorsement: This is equivalent to any form whose Form Type on the SERFF Form Schedule may accurately be described as END. 2 Mandatory: The Endorsement is issued on all policies. 3 Optional: The Endorsement is issued at the sole discretion of the Filing Company based upon underwriting, with no option of the applicant/insured to decline. 4 Elected: The Endorsement may be elected or declined by the applicant/insured. PFR-PEL (ed. 01/12)

20 POLICY NUMBER: BUSINESSOWNERS BPM 3111MA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MASSACHUSETTS - GARAGEKEEPERS BROAD COVERAGE This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SECTION II - LIABILITY With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Location Number Address Where You Conduct Garage Operations (Main Location) Coverages Limit Of Insurance And Deductible Premium Comprehensive $ Minus $ $ Deductible For All Perils Subject To $ Maximum Deductible For All Such Loss In Any One Event. Collision $ Minus $ $ Deductible For Each Customer's Auto. Location Number Address Where You Conduct Garage Operations Coverages Limit Of Insurance And Deductible Premium Comprehensive $ Minus $ $ Deductible For All Perils Subject To $ Maximum Deductible For All Such Loss In Any One Event. Collision $ Minus $ $ Deductible For Each Customer's Auto. BPM 3111MA Page 1 of 3

21 Location Number Address Where You Conduct Garage Operations Coverages Limit Of Insurance And Deductible Premium Comprehensive $ Minus $ $ Deductible For All Perils Subject To $ Maximum Deductible For All Such Loss In Any One Event. Collision $ Minus $ $ Deductible For Each Customer's Auto. Total Premium For All Locations $ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. COVERAGE OPTIONS Indicated below with an "X" which, if any, Coverage Option is selected. LEGAL LIABILITY If this box is checked, coverage applies on the basis of the insured s legal liability. DIRECT PRIMARY If this box is checked, coverage applies without regard to your or any other "insured's" legal liability for "loss" to a "customer's auto" and is primary insurance. A. This endorsement provides only those coverages: 1. Where a Limit of Insurance and a premium are shown for that coverage in the Schedule; and 2. For the location shown in the Schedule. B. Coverage 1. We will pay all sums the "insured" legally must pay as damages for "loss" to a "customer's auto" or "customer's auto" equipment left in the "insured's" care while the "insured" is attending, servicing, repairing, parking or storing it in your "garage operations" under: a. Comprehensive Coverage From any cause except: (1) The "customer's auto's" collision with another object; or (2) The "customer's auto's" overturn. b. Collision Coverage Caused by: (1) The "customer's auto's" collision with another object; or (2) The "customer's auto's" overturn. 2. We will have the right and duty to defend any "insured" against a "suit" asking for these damages. However, we have no duty to defend any "insured" against a "suit" seeking damages for "loss" to which this insurance does not apply. We may investigate and settle any claim or "suit" as we consider appropriate. Our duty to defend or settle ends for a coverage when the Limit of Insurance for that coverage has been exhausted by payment of judgments or settlements. C. Exclusions 1. This insurance does not apply to any of the following: a. Contractual Obligations Liability resulting from any contract or agreement by which the "insured" accepts responsibility for "loss". But this exclusion does not apply to liability for "loss" that the "insured" would have in the absence of the contract or agreement. Page 2 of 3 BPM 3111MA

22 b. Theft "Loss" due to theft or conversion caused in any way by you, your "employees" or by your shareholders. c. Defective Parts Defective parts or materials. d. Faulty Work Faulty "work you performed". 2. We will not pay for "loss" to any of the following: a. Tapes, records, discs and other sound reproducing devices designed for use with sound reproducing equipment. b. Any device designed or used to detect speed measurement equipment such as radar or laser detectors and any jamming apparatus intended to elude or disrupt speed measurement equipment. 3. We will not pay for "loss" caused by or resulting from the following. Such "loss" is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the "loss": a. War, including undeclared or civil war; b. Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or c. Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. D. Limits Of Insurance And Deductibles 1. Regardless of the number of "customer's autos", "insureds", premiums paid, claims made or "suits" brought, the most we will pay for each "loss" at each location is the Limit of Insurance shown in the Schedule for that location minus the applicable deductibles for "loss" caused by: a. Collision; or b. Comprehensive 2. The maximum deductible stated in the Schedule for Comprehensive or Coverage is the most that will be deducted for all "loss" in any one event. 3. Sometimes to settle a claim or "suit", we may pay all or any part of the deductible. If this happens you must reimburse us for the deductible or that portion of the deductible that we paid. E. Conditions The following Conditions apply to Physical Damage Coverage. Actual Cash Value Whenever the appraised cost of repair of an auto plus the probable salvage value of the auto may be reasonably expected to exceed the actual case value of the auto, we shall determine the auto s actual cash value. Our determination shall be based on a consideration of all of the following factors: 1.) The retail book value for an auto of like kind and quality, but for the damage incurred; 2.) The price paid for the auto plus the value of prior improvements to the auto at the time of the accident, less appropriate depreciation; 3.) The decrease in value of the auto resulting from prior unrelated damage which is detected by the appraiser; and 4.) The actual cost of purchase of an available auto of like kind and quality but for the damage sustained. E,F. Additional Definitions As used in this endorsement: 1. "Customer's auto" means a customer's land motor vehicle or trailer or semitrailer. This definition also includes any customer's auto while left with you for service, repair, storage or safekeeping. Customers include your "employees", and members of their households who pay for services performed. 2. "Loss" means direct and accidental loss or damage and includes any resulting loss of use. 3. "Garage operations" means the ownership, maintenance or use of locations for the purpose of a business of selling, servicing, repairing, parking or storing "customer's autos" and that portion of the roads or other accesses that adjoin these locations. "Garage operations" also includes all operations necessary or incidental to the performance of garage operations. 4. "Work you performed" includes: a. Work that someone performed on your behalf; and b. The providing of or failure to provide warnings or instructions. BPM 3111MA Page 3 of 3

23 RESET FORM MASSACHUSETTS DIVISION OF INSURANCE FORM UTILIZATION LIST NOTE: Terms used herein are defined below and an example is provided on the first line for your convenience. INSTRUCTIONS: For filings containing Policy Forms, please provide the requested information for all previously-filed Ancillary Forms to be used with them. Likewise, for filings containing Ancillary Forms, please provide the requested information for all previously-filed Policy Forms with which they will be used. Please do NOT include in this List forms submitted for review in this filing. If your List is extensive, please use the second page as many times as necessary. For Property and Casualty Filings, these instructions apply also to any forms filed on the Filing Company s behalf by a rating organization. Main Street America Assurance Company Please enter the corporate name and nine-digit NAIC number (e.g., ) of the First Filing Company. Mainline Businessowners Policy Please enter the product name as filed. Form Name Form Number Disposition Date State/SERFF Tr Num ABC Insurance Benefit Form ABC 0001 (01/10) April 1, 2010 ABCI Section II - Liability Coverage BPM P 2 12/07 January 7, 2009 NGMC Section III - Common Policy Conditions BPM P 3 01/09 January 7, 2009 NGMC Policy Form: This is equivalent to any form whose Form Type on the SERFF Form Schedule may accurately be described as A.) PCF and CER in Property and Casualty filings, or as B.) POL and CER in Life, Annuity, Credit and Accident & Sickness filings. Ancillary Form: This is equivalent to any form whose Form Type on the SERFF Form Schedule may accurately be described as A.) END, ABE, ERS, DEC and OTH in Property and Casualty filings, or as B.) POLA, CERA, OUT, NOC, DEP, PJK and OTH in Life, Annuity, Credit and Accident & Sickness filings. Disposition Date: This is the date that the Division completed its review of the form and either approved it or placed it on file (or the date a Filing Company adopted the form from a rating organization for its use). Please note that this date may not always be the same as the Effective Date. PFR-FUL (ed. 01/11)

24 RESET FORM MASSACHUSETTS DIVISION OF INSURANCE CERTIFICATION OF COMPLIANCE Main Street America Assurance Company (MSAA) (Please enter the corporate name of the First Filing Company, hereinafter referred to as the Filing Entity. ) MSAA BOP (Please enter the Company Tracking Number or SERFF Tracking Number, hereinafter referred to as the Filing. ) Daniel Gaynor VP, Commercial Lines I,,, Name Title as a representative of the Filing Entity and duly authorized to give this certification on its behalf, hereby certify under the pains and penalties of perjury that this Filing is in compliance with all relevant laws and regulations of the Commonwealth of Massachusetts. Signature June 20, 2012 Date SRB-CC (ed. 01/11)

25 MASSACHUSETTS DIVISION OF INSURANCE BASE CHECKLIST FOR PROPERTY AND CASUALTY INSURANCE Page 1 of 5 RESET FORM PFR-B-PAC (ed. 01/12) Policy/Coverage Form #: BPM 3111MA (Please enter only one number per checklist; if none, leave blank.) CHECKLIST INSTRUCTIONS 1) A completed copy of this checklist is required for each Policy/Coverage Form being submitted. 2) For purposes of these instructions, a Policy/Coverage Form is: a) a base coverage form of a property and/or casualty insurance policy; or b) an endorsement providing property or casualty insurance of a type other than that provided in the base coverage form to which it will be attached. 3) If the filing contains no Policy/Coverage Forms, please submit a checklist with the General Form Requirements, Policy Prohibitions and/or General Rate Requirements sections, as well as any other applicable sections, completed. 4) All page and paragraph references should refer back to the place in the form, memorandum or other document where compliance is demonstrated. 5) A brief explanation should be provided for all items considered not applicable to the filed materials; N/A is not a sufficient explanation. PLEASE NOTE THE FOLLOWING 1) Credit property insurance and credit involuntary unemployment insurance products also require a completed Supplemental Checklist. 2) Legal service plans subject to 211 CMR require submission of the Base Checklist for Legal Service Plans, and not this checklist. 3) Motor vehicle insurance products and workers compensation insurance products require submission of different checklists, and not this checklist. 4) All laws relative to the filing of policy/coverage forms apply to their endorsements and attached applications under M.G.L. 175, 192. GENERAL FORM REQUIREMENTS If not filing forms, check here and skip section: ID Brief Requirement Description Compliance Brief Explanation, if Not Applicable GR1 10-point font, readability score of 50, and other minimum objective standards of M.G.L. 175, 2B. Check: GR2 Effective date 30 days from submission. M.G.L. 175, 22A Check: Always applicable GR3 Form headed by corporate name of company. FGN 2006-A Check: See Filing Description GR4 Signatures. M.G.L. 175, 33 Page, Para. GR5 Applications constituting part of the contract designed to be attached to the policy. M.G.L. 175, 192 Check: N/A.Not part of contract. Opt coverage if selected by UW COMBINATION POLICIES M.G.L. 175, 102A and 111A If not filing a combination policy, check here and skip section: ID Brief Requirement Description Compliance Brief Explanation, if Not Applicable CP1 Percentage of loss or claim. Page, Para. CP2 Required notices, sworn statements, or proofs of loss. Page, Para. CP3 Service of process in actions or suits. Page, Para. CP4 Return premium upon cancellation. Page, Para. CP5 Elimination/Reduction of coverage (liability only). Page, Para. MUTUAL COMPANY POLICY PROVISIONS If not a mutual company, check here and skip section: ID Brief Requirement Description Compliance Brief Explanation, if Not Applicable MC1 Contingent mutual liability. M.G.L. 175, 102A(4) and 111A(4) Page, Para. MC2 Meetings of the company. M.G.L. 175, 76 and 102B Page, Para. Form #:

26 MASSACHUSETTS DIVISION OF INSURANCE BASE CHECKLIST FOR PROPERTY AND CASUALTY INSURANCE Page 2 of 5 MC3 Separate classifications of business. M.G.L. 175, 80 and 102B Page, Para. MC4 Total amount of liability. M.G.L. 175, 81 Page, Para. MC5 Application questions. M.G.L. 175, 98 and 111B Page, Para. MC6 Assessment liability. M.G.L. 175, 83, 93 and 111B Page, Para. FIRE POLICY STANDARD FORM M.G.L. 175, 99(12) If not filing property insurance, check here and skip section: ID Brief Requirement Description Compliance Brief Explanation, if Not Applicable FP1 Insurance agreement. Page, Para. FP2 Assignment of the policy. Page, Para. FP3 Policy subject to its provisions and stipulations. Page, Para. FP4 Witness provision. Page, Para. FP5 Voiding of the policy. Page, Para. FP6 Items not covered. Page, Para. FP7 Fire exclusions. Page, Para. FP8 Other insurance. Page, Para. FP9 Other exclusions. Page, Para. FP10 Other perils insured against. Page, Para. FP11 Extent of insurance. Page, Para. FP12 Permission and waiver. Page, Para. FP13 Appraisal and examinations. Page, Para. FP14 Cancellation by insured. Page, Para. FP15 Cancellation by company. Page, Para. FP16 Excess premium at cancellation. Page, Para. FP17 Cancellation after 60 days. Page, Para. FP18 Cancellation for nonpayment of premium. Page, Para. FP19 Policy payable to mortgagees. Page, Para. FP20 Proportion of loss. Page, Para. FP21 Notice and proof of loss. Page, Para. FP22 Payment of claim. Page, Para. FP23 Dispute resolution for claims. Page, Para. FP24 Suits for recovery of claims. Page, Para. FP25 Assignment of right of recovery. Page, Para. NB: M.G.L. 175, 99 does not apply to insurance against the hazards described in the Second and Third clauses of M.G.L. 175, 47. ADDITIONAL PROPERTY PROVISIONS If not filing property insurance, check here and skip section: ID Brief Requirement Description Compliance Brief Explanation, if Not Applicable AP1 In case of fire notice. M.G.L. 175, 99(7) Page, Para. AP2 Certificate of municipal liens. M.G.L. 175, 99(14) Page, Para. AP3 Notice to building commissioner. M.G.L. 175, 99(15) Page, Para. AP4 Cost of relocation benefit. M.G.L. 175, 99(15A) Page, Para. PFR-B-PAC (ed. 01/12)

27 PFR-B-PAC (ed. 01/12) MASSACHUSETTS DIVISION OF INSURANCE BASE CHECKLIST FOR PROPERTY AND CASUALTY INSURANCE Page 3 of 5 AP5 Elimination/Reduction in coverage. M.G.L. 175, 99(16) Page, Para. AP6 Damage by nuclear reaction or nuclear contamination. M.G.L. 175, 99A Page, Para. AP7 Loss settlement clause. M.G.L. 175, 99B Page, Para. AP8 Notice of non-renewal. M.G.L. 175, 193P Page, Para. AP9 Mold exclusion requirements. Bulletin Page, Para. ff. AP10 Heating oil release coverage requirements for residential property as defined in M.G.L. 175, 4D. Bulletin Page, Para. ff. AP11 Minimum guaranteed replacement cost coverage cap of 125% of the amount of insurance (homeowners insurance). Page, Para. CLAIMS-MADE GENERAL LIABILITY PROVISIONS FGN 2011-A If not filing a general liability policy, check here and skip section: ID Brief Requirement Description Compliance Brief Explanation, if Not Applicable GL1 Retroactive Date Endorsement. 1.a Check: Form #: GL2 Termination of coverage. 1.b Page, Para. Always applicable GL3 Automatic extended reporting period. 1.c Page, Para. Always applicable GL4 Additional extended reporting period coverage available for purchase. 1.d.1 Page, Para. Always applicable GL5 Minimum 3-year additional extended reporting period. 1.d.ii Page, Para. Always applicable GL6 Aggregate liability limit for additional extended reporting period coverage. 1.d.iii Page, Para. Always applicable GL7 Deadline for written acceptance of additional extended reporting period coverage. 1.d.iv Page, Para. Always applicable GL8 Claims-made face page disclosure. 2 Check: Always applicable LEAD LIABILITY PROVISIONS M.G.L. 175, 111H If not covering residential premises, check here and skip section: ID Brief Requirement Description Compliance Brief Explanation, if Not Applicable LL1 Premises with letter in effect. 211 CMR Page, Para. LL2 Premises with letter obtained and maintained. 211 CMR Page, Para. LL3 New owners. 211 CMR Page, Para. LL4 Additional requirements. 211 CMR Page, Para. LL5 Premises not in compliance. 211 CMR Page, Para. LL6 Owner-occupied single family premises. 211 CMR Page, Para. LL7 Coverage summary. 211 CMR (1) Check: LL8 Disclosure notice. 211 CMR (2) Check: ADDITIONAL LIABILITY PROVISIONS If not filing liability insurance, check here and skip section: ID Brief Requirement Description Compliance Brief Explanation, if Not Applicable AL1 Medical pay provisions. M.G.L. 175, 111C Page, Para.