Supplemental Application for Massachusetts Motor Vehicle Insurance (must be completed and submitted with all Personal Auto applications)

Transcription

1 Supplemental Application for Massachusetts Motor Vehicle Insurance (must be completed and submitted with all al Auto applications) Company: The Commerce Insurance Company Named Insured Producer Name: Mailing Address City/State Zip Code Producer Code: address: Home Phone: Cell Phone: Policy Effective Date: 1. Do you have Property Insurance on your principal place of residence? Yes No If yes, and your principal place of residence is in Massachusetts, please provide the following information, as you may be eligible for an Account Discount. What company is your property policy with? What type of property policy do you have? Commerce/Citation Fair Plan Other (Name) Homeowners with HO-15 Condo (owner occupied) Renters Homeowners without HO Do you have an Umbrella Policy or Endorsement with Commerce or Citation? If yes, please provide the Policy Number. 3. Do you have a Life Policy with MAPFRE Life Insurance Company? If yes, please provide the Policy Number. 4. How long have you been living at your current residence? 5. Have you had a lapse in auto insurance coverage in the past 12 months? Yes No 6. Do you currently have a al Automobile Insurance Policy? Yes No If Yes: a. What is the name of your current insurance carrier? b. How many months have you been with your current insurance carrier? c. Which of the following limit ranges does your Bodily Injury Limit belong? (if varying limits by vehicle, please choose based on the highest limit) < or = 20/60 100/100 to <250/500 25/50 to <50/50 > or = 250/500 50/50 to <100/ Have you been previously insured with Commerce Insurance during the past 24 months? Yes No 8. How many automobiles in addition to your motorcycle, do you have insured with Commerce Insurance? 9. Do you have a Foreign Driver s License? If yes, attach a copy of the front and back of the drivers Yes No license to this application. 10. Were you previously licensed to drive outside of Massachusetts or in a foreign country? Yes No If yes, attach a 917 Form for possible driving credit. 11. Do you drive less than 20,001 miles annually and qualify for the Annual Mileage Discount (AMD)? Yes No If yes, attach a copy of the AMD Form, CIC-750 to this application. The insured can also submit their current odometer reading anytime by accessing the Annual Mileage page through their CommerceCares.com account. 12. Would you like to purchase the Commerce Enhancer Package Endorsement for an additional premium? Yes No 13. Would you like to purchase the Commerce Elite Package Endorsement for an additional premium? Yes No 14. Would you like to purchase Auto Loan/Lease Coverage for any of your vehicles for an additional premium? Yes No Please check applicable vehicle: #1 #2 #3 #4 15. Would you like to purchase Accident Forgiveness for an additional premium? Yes No 16. Would you like to purchase the Motorcycle Accessory Endorsement for an additional premium? Yes No Please indicate the limit you would like for each applicable vehicle: #1 #2 #3 #4 CIC-2115 (12/14) (See Reverse Page for Required Applicant Signature) Page 1 of 2 Deleted: 7 Deleted: 8 Deleted: 9 Deleted: 10 Deleted: 11 Deleted: 12 Deleted: 13 Deleted: 14 Deleted: 15 Deleted: 11

2 17. Are any of the listed operators eligible for the Good Student Discount (GSD)? Yes No If yes, please attach a completed GSD Form CIC-2134, or a copy of the operator s most recent report card to this application. 18. Are any of the listed operators eligible for the Student Away from Home Discount? Yes No If yes, please provide the name(s) of the operator(s): 19. Are any of the listed operators eligible for the Smart Driver Discount? Yes No If yes, please check off the appropriate course below including the driver s name and course completion date. Deleted: 16 Deleted: 17 Deleted: 18 Course: Drivers Name: Completion Date: ADT Driven ADT In Control ADT Stevens ADT Central MA DSDP teensmart 20. Will you be enrolled in either CIC s Electronic Fund Transfer program (EFT) or Electronic Invoice (e-bill) program and signed up to view and receive policy forms electronically on CWEB (e-policy) to qualify for the Green Discount? Yes No 21. Are you a AAA Member? Yes No If yes, please provide your Member ID Number: and the Year you joined:. 22. If your annual policy premium is paid in full, you are eligible to receive the Paid-In-Full Discount. The following exceptions apply: (1) National Standard and Named Non-Owned Policies (2) Finance company payments 23. If you have resided at the same residence for 7 or more years, or your policy is submitted to Commerce at least 7 days prior to the effective date, you may qualify for the Shop Smart Discount. The following exceptions apply: (1) You were insured by Commerce within the last 6 months (2) There has been a lapse in coverage within the last 3 years 24. Is this vehicle used in a Car/Ride Sharing program, leased or loaned to others for Compensation, or used in any capacity to transport passengers for a fee? Yes No I declare that all the statements contained in this Supplemental Application are complete and true to the best of my knowledge as of this date. I understand that the company may exchange payment of premium information and accident or claim information with my previous automobile insurance company. Signature of Applicant Date and Time Deleted: 19 Deleted: 20 Deleted: 21 Deleted: 22 Deleted: 23 TO BE COMPLETED BY PRODUCER: The information contained in this application is as told to me by the applicant and is true and complete to the best of my knowledge. Signature of Producer Date and Time IF THIS APPLICATION IS BEING ELECTRONICALLY TRANSMITTED, THE FOLLOWING MUST ALSO BE COMPLETED: I agree to be bound by this electronic record and it shall have the same legal force and effect as the written application. Applicant s Name Date Ways To Save Guide Consumer Notification In accordance with Massachusetts General Laws, we, The Commerce Insurance Company, are required to provide you, the consumer, with the following required consumer information guide: Your Consumer Guide Ways To Save on your Automobile Insurance ( Ways to Save Guide ). The Ways to Save Guide is important for all policyholders as it provides a detailed description of compulsory coverages, optional coverages, and ways to lower your premium. In addition, it provides important information to help consumers understand how driving records impact insurance premiums. You may choose to receive the Ways to Save Guide either electronically, by accessing our company website at you may us at waystosave@mapfreusa.com, or you may contact The Commerce Insurance Company at extension if you would like to receive a free paper copy. If you have any questions regarding the Ways to Save Guide, please contact The Commerce Insurance Company at extension CIC-2115 (12/14) Page 2 of 2 Deleted: 11

3 Supplemental Application for Massachusetts Motor Vehicle Insurance (must be completed and submitted with all al Auto applications) Company: The Commerce Insurance Company Named Insured Producer Name: Mailing Address City/State Zip Code Producer Code: address: Home Phone: Cell Phone: Policy Effective Date: 1. Do you have Property Insurance on your principal place of residence? Yes No If yes, and your principal place of residence is in Massachusetts, please provide the following information, as you may be eligible for an Account Discount. What company is your property policy with? What type of property policy do you have? Commerce/Citation Fair Plan Other (Name) Homeowners with HO-15 Condo (owner occupied) Renters Homeowners without HO Do you have an Umbrella Policy or Endorsement with Commerce or Citation? If yes, please provide the Policy Number. 3. Do you have a Life Policy with MAPFRE Life Insurance Company? If yes, please provide the Policy Number. 4. How long have you been living at your current residence? 5. Have you had a lapse in auto insurance coverage in the past 12 months? Yes No 6. Do you currently have a al Automobile Insurance Policy? Yes No If Yes: a. What is the name of your current insurance carrier? b. How many months have you been with your current insurance carrier? c. Which of the following limit ranges does your Bodily Injury Limit belong? (if varying limits by vehicle, please choose based on the highest limit) < or = 20/60 100/100 to <250/500 25/50 to <50/50 > or = 250/500 50/50 to <100/ Have you been previously insured with Commerce Insurance during the past 24 months? Yes No 8. How many automobiles in addition to your motorcycle, do you have insured with Commerce Insurance? 9. Do you have a Foreign Driver s License? If yes, attach a copy of the front and back of the drivers Yes No license to this application. 10. Were you previously licensed to drive outside of Massachusetts or in a foreign country? Yes No If yes, attach a 917 Form for possible driving credit. 11. Do you drive less than 20,001 miles annually and qualify for the Annual Mileage Discount (AMD)? Yes No If yes, attach a copy of the AMD Form, CIC-750 to this application. The insured can also submit their current odometer reading anytime by accessing the Annual Mileage page through their CommerceCares.com account. 12. Would you like to purchase the Commerce Enhancer Package Endorsement for an additional premium? Yes No 13. Would you like to purchase the Commerce Elite Package Endorsement for an additional premium? Yes No 14. Would you like to purchase Auto Loan/Lease Coverage for any of your vehicles for an additional premium? Yes No Please check applicable vehicle: #1 #2 #3 #4 15. Would you like to purchase Accident Forgiveness for an additional premium? Yes No 16. Would you like to purchase the Motorcycle Accessory Endorsement for an additional premium? Yes No Please indicate the limit you would like for each applicable vehicle: #1 #2 #3 #4 CIC-2115 (12/14) (See Reverse Page for Required Applicant Signature) Page 1 of 2

4 17. Are any of the listed operators eligible for the Good Student Discount (GSD)? Yes No If yes, please attach a completed GSD Form CIC-2134, or a copy of the operator s most recent report card to this application. 18. Are any of the listed operators eligible for the Student Away from Home Discount? Yes No If yes, please provide the name(s) of the operator(s): 19. Are any of the listed operators eligible for the Smart Driver Discount? Yes No If yes, please check off the appropriate course below including the driver s name and course completion date. Course: Drivers Name: Completion Date: ADT Driven ADT In Control ADT Stevens ADT Central MA DSDP teensmart 20. Will you be enrolled in either CIC s Electronic Fund Transfer program (EFT) or Electronic Invoice (e-bill) program and signed up to view and receive policy forms electronically on CWEB (e-policy) to qualify for the Green Discount? Yes No 21. Are you a AAA Member? Yes No If yes, please provide your Member ID Number: and the Year you joined:. 22. If your annual policy premium is paid in full, you are eligible to receive the Paid-In-Full Discount. The following exceptions apply: (1) National Standard and Named Non-Owned Policies (2) Finance company payments 23. If you have resided at the same residence for 7 or more years, or your policy is submitted to Commerce at least 7 days prior to the effective date, you may qualify for the Shop Smart Discount. The following exceptions apply: (1) You were insured by Commerce within the last 6 months (2) There has been a lapse in coverage within the last 3 years 24. Is this vehicle used in a Car/Ride Sharing program, leased or loaned to others for Compensation, or used in any capacity to transport passengers for a fee? Yes No I declare that all the statements contained in this Supplemental Application are complete and true to the best of my knowledge as of this date. I understand that the company may exchange payment of premium information and accident or claim information with my previous automobile insurance company. Signature of Applicant Date and Time TO BE COMPLETED BY PRODUCER: The information contained in this application is as told to me by the applicant and is true and complete to the best of my knowledge. Signature of Producer Date and Time IF THIS APPLICATION IS BEING ELECTRONICALLY TRANSMITTED, THE FOLLOWING MUST ALSO BE COMPLETED: I agree to be bound by this electronic record and it shall have the same legal force and effect as the written application. Applicant s Name Date Ways To Save Guide Consumer Notification In accordance with Massachusetts General Laws, we, The Commerce Insurance Company, are required to provide you, the consumer, with the following required consumer information guide: Your Consumer Guide Ways To Save on your Automobile Insurance ( Ways to Save Guide ). The Ways to Save Guide is important for all policyholders as it provides a detailed description of compulsory coverages, optional coverages, and ways to lower your premium. In addition, it provides important information to help consumers understand how driving records impact insurance premiums. You may choose to receive the Ways to Save Guide either electronically, by accessing our company website at you may us at waystosave@mapfreusa.com, or you may contact The Commerce Insurance Company at extension if you would like to receive a free paper copy. If you have any questions regarding the Ways to Save Guide, please contact The Commerce Insurance Company at extension CIC-2115 (12/14) Page 2 of 2

5 COVERAGE SELECTIONS PAGE This page and any attached endorsements form a part of your policy This policy is issued by: The Commerce Insurance Company [INSERT CIC LOGO] Webster, MA Item 1: This policy is issued to: Massachusetts al Automobile Policy Number: Agent: Item 2: This policy is in effect from: to (12:01 A.M Eastern Standard Time) Item 3: Description of your Auto: AUTO AUTO Item 4: This policy provides only the coverages for which a premium charge is shown: Coverages, s 1-12 AUTO AUTO COMPULSORY INSURANCE LIMITS 1 Bodily Injury To Others Accident 2 al Injury Protection 3 Bodily Injury Caused By An Uninsured Auto (Compulsory Limits $20,000 / $40,000) 4 Damage To Someone Else s Property (Compulsory Limits $5,000) OPTIONAL INSURANCE 5 Optional Bodily Injury To Others Accident Accident Accident 6 Medical Payments Deductible $ Annual Premium Adjusted Premium LIMITS Deductible None $ $ Accident $ $ yourself yourself and household members None $ $ Accident None $ $ Accident None $ $ Accident None $ $ $ Annual Premium None $ $ yourself yourself and household members $ $ None $ $ None $ $ None $ $ None $ $ 7 Collision Actual Cash Value $ $ $ Actual Cash Value $ $ $ 8 Limited Collision Actual Cash Value $ $ $ Actual Cash Value $ $ $ 9 Comprehensive Actual Cash Value $ $ $ Actual Cash Value $ $ $ 10 Substitute Transportation Up to $ a day, maximum $ 11 Towing and Labor Up to $ for each disablement 12 Bodily Injury Caused By An Underinsured Auto Accident None $ $ Up to $ a day, maximum $ None $ $ Up to $ for each disablement None $ $ Accident None $ $ None $ $ None $ $ MERIT RATING PLAN Premium Adjustment $ $ Premium Adjustment $ $ PREMIUM (per AUTO) AUTO $ $ AUTO $ $ TOTAL PREMIUM (POLICY) $ Adjusted Premium Disappearing Deductible Credits as of xx/xx/xxxx: $x DISCOUNTS AUTO AUTO Account Age 65 and older Annual Mileage Anti Theft Good Student MCD Shop Smart Student Away Motorcycle Training Pay Plan Smart Driver Clean in 3 Welcome Back REFER TO OTHER SIDE FOR ADDITIONAL INFORMATION PAGE 1 of X (Note: For policies with 3 or 4 autos, there will be 2 of this page) (12/14) Deleted: 11 Deleted: 13

6 AUTO AUTO AUTO AUTO Item 5: Principal Place of Garaging Item 6: Secured Lender/Lessor Additional Insured, if Rented Auto Op No Operator Name Date of Birth License Number Lic. State Clean in Three CIC Merit Rating OPERATOR INFORMATION Date First Licensed Driver T=Trning S=Smart B=Both Student G=Good A=Away B=Both Def Op Y/N Operator Status O=Occasional, P=Principal, E=Excluded, M=Military Auto Motorcycle V1 V2 V3 V4 Identification Numbers of Endorsements Forming a of This Policy: Additional Information: MERIT RATING PLAN The Merit Rating Plan premium adjustment for each auto is based on the driving records of the operators listed on your policy. Premium adjustments can result from incident-free driving, or from a Merit Rating Board report of an at-fault accident or traffic law violation during the five year period immediately preceding the policy effective date. The Merit Rating Board code and class of each operator are used in assigning the operators to the autos in the manner described in the rating manual. Check carefully that all operators of your auto(s) are shown. Your failure to list a household member or any individual who customarily operates your auto may have very serious consequences. NOTICE: You must notify us of changes that have occurred prior to the renewal of this policy and during the policy period. It is a crime to knowingly provide false or fraudulent information for the purpose of defrauding an insurance company. If you or someone else on your behalf has knowingly given us false, deceptive, misleading or incomplete information and if such false, deceptive, misleading or incomplete information increases our risk of loss, we may refuse to pay claims under any or all of the Optional Insurance s and we may cancel your policy. Such information includes the description and the place of garaging of the vehicle(s) to be insured, the names of all household members and customary operators required to be listed and the answers given above for all listed operators. We may also limit our payments under 3 and 4. Check to make certain that you have correctly listed all operators and the completeness of their previous driving records. The Merit Rating Board may verify the accuracy of the previous driving records of all listed operators. We will not pay for a collision or limited collision loss for an accident which occurs while your auto is being operated by a household member who is not listed as an operator on your policy. Payment is withheld when the household member, if listed, would require the payment of additional premium on your policy because the household member would be classified as an inexperienced operator or would require payment of additional premium on your policy under the Merit Rating Plan. Auto Rating Class Prem. Town Stat Class Risk Type Age HT CMP Annual Mileage Risk Level Years Lic Group MR Group CIC Loy Group AAA Loy Group Comp Sym Coll Sym Liab Sym PIP/MP Sym CO Batch Seq Rep Curr Dt Run Seq End No Last Run DT Rate Type HH Level EDF USE PAGE X of X (Note: There will only be one of this page per policy) Countersigned by Authorized Agent (12/14) Deleted: 11 Deleted: 13

7 COVERAGE SELECTIONS PAGE This page and any attached endorsements form a part of your policy This policy is issued by: The Commerce Insurance Company [INSERT CIC LOGO] Webster, MA Item 1: This policy is issued to: Massachusetts al Automobile Policy Number: Agent: Item 2: This policy is in effect from: to (12:01 A.M Eastern Standard Time) Item 3: Description of your Auto: AUTO AUTO Item 4: This policy provides only the coverages for which a premium charge is shown: Coverages, s 1-12 AUTO AUTO COMPULSORY INSURANCE LIMITS 1 Bodily Injury To Others Accident 2 al Injury Protection 3 Bodily Injury Caused By An Uninsured Auto (Compulsory Limits $20,000 / $40,000) 4 Damage To Someone Else s Property (Compulsory Limits $5,000) OPTIONAL INSURANCE 5 Optional Bodily Injury To Others Accident Accident Accident 6 Medical Payments Deductible Annual Premium Adjusted Premium LIMITS Deductible None $ $ Accident $ yourself yourself and household members $ $ None $ $ Accident None $ $ Accident None $ $ Accident None $ $ Annual Premium None $ $ $ yourself yourself and household members $ $ None $ $ None $ $ None $ $ None $ $ 7 Collision Actual Cash Value $ $ $ Actual Cash Value $ $ $ 8 Limited Collision Actual Cash Value $ $ $ Actual Cash Value $ $ $ 9 Comprehensive Actual Cash Value $ $ $ Actual Cash Value $ $ $ 10 Substitute Transportation Up to $ a day, maximum $ 11 Towing and Labor Up to $ for 12 Bodily Injury Caused By An Underinsured Auto each disablement Accident None $ $ Up to $ a day, maximum $ None $ $ Up to $ for each disablement None $ $ Accident None $ $ None $ $ None $ $ MERIT RATING PLAN Premium Adjustment $ $ Premium Adjustment $ $ PREMIUM (per AUTO) AUTO $ $ AUTO $ $ TOTAL PREMIUM (POLICY) $ Adjusted Premium Disappearing Deductible Credits as of xx/xx/xxxx: $x DISCOUNTS AUTO AUTO Account Age 65 and older Annual Mileage Anti Theft Good Student MCD Shop Smart Student Away Motorcycle Training Pay Plan Smart Driver Clean in 3 Welcome Back REFER TO OTHER SIDE FOR ADDITIONAL INFORMATION PAGE 1 of X (Note: For policies with 3 or 4 autos, there will be 2 of this page) (12/14)

8 AUTO AUTO AUTO AUTO Item 5: Principal Place of Garaging Item 6: Secured Lender/Lessor Additional Insured, if Rented Auto Op No Operator Name Date of Birth License Number Lic. State Clean in Three CIC Merit Rating OPERATOR INFORMATION Date First Licensed Driver T=Trning S=Smart B=Both Student G=Good A=Away B=Both Def Op Y/N Operator Status O=Occasional, P=Principal, E=Excluded, M=Military Auto Motorcycle V1 V2 V3 V4 Identification Numbers of Endorsements Forming a of This Policy: Additional Information: MERIT RATING PLAN The Merit Rating Plan premium adjustment for each auto is based on the driving records of the operators listed on your policy. Premium adjustments can result from incident-free driving, or from a Merit Rating Board report of an at-fault accident or traffic law violation during the five year period immediately preceding the policy effective date. The Merit Rating Board code and class of each operator are used in assigning the operators to the autos in the manner described in the rating manual. Check carefully that all operators of your auto(s) are shown. Your failure to list a household member or any individual who customarily operates your auto may have very serious consequences. NOTICE: You must notify us of changes that have occurred prior to the renewal of this policy and during the policy period. It is a crime to knowingly provide false or fraudulent information for the purpose of defrauding an insurance company. If you or someone else on your behalf has knowingly given us false, deceptive, misleading or incomplete information and if such false, deceptive, misleading or incomplete information increases our risk of loss, we may refuse to pay claims under any or all of the Optional Insurance s and we may cancel your policy. Such information includes the description and the place of garaging of the vehicle(s) to be insured, the names of all household members and customary operators required to be listed and the answers given above for all listed operators. We may also limit our payments under 3 and 4. Check to make certain that you have correctly listed all operators and the completeness of their previous driving records. The Merit Rating Board may verify the accuracy of the previous driving records of all listed operators. We will not pay for a collision or limited collision loss for an accident which occurs while your auto is being operated by a household member who is not listed as an operator on your policy. Payment is withheld when the household member, if listed, would require the payment of additional premium on your policy because the household member would be classified as an inexperienced operator or would require payment of additional premium on your policy under the Merit Rating Plan. Auto Rating Class Prem. Town Stat Class Risk Type Age HT CMP Annual Mileage Risk Level Years Lic Group MR Group CIC Loy Group AAA Loy Group Comp Sym Coll Sym Liab Sym PIP/MP Sym CO Batch Seq Rep Curr Dt Run Seq End No Last Run DT Rate Type HH Level EDF USE Countersigned by Authorized Agent PAGE X of X (Note: There will only be one of this page per policy) (12/14)

9 TABLE OF CONTENTS Page Rule No. SECTION I - GENERAL RULES 1 Massachusetts Automobile Insurance Policy - Eligibility Coverages and Limits Mandatory Offer of Coverage Standard Procedures Residence and Location Out-of-State Garaging Policy Period Changes Motor Vehicle Registration Certificates Certified Risks - Financial Responsibility Laws Premium Calculation Rule Whole Dollar Premium Rule Installment Payment of Premiums Deposit Premium Rule Employers Subject to Massachusetts Workers Compensation Act Deductibles - s 7, 8 and Substitute Transportation Termination of Insurance Discounts and Credits Vehicle Liability Symbols Model Year Rating Non-Symbolled Vehicles and Rating Vehicles for which Symbols are not shown On the Rate Pages High-Theft Vehicles Extra-Risk Rating (Collision and Comprehensive) Vehicle Series Rating Additional Company Rating Rules Years Licensed Risk Factor Driver Vehicle Factor Loyalty Plus Factor HH Level Factor Hardship Accommodation Rule No. SECTION II - PRIVATE PASSENGER AUTOMOBILES 27 Private Passenger Definition Private Passenger Classifications Reserved For Future Use al Injury Protection - Deductible Form Transportation of Fellow Employees TC - 1

10 TABLE OF CONTENTS Page Rule No. SECTION I - GENERAL RULES 1 Massachusetts Automobile Insurance Policy - Eligibility Coverages and Limits Mandatory Offer of Coverage Standard Procedures Residence and Location Out-of-State Garaging Policy Period Changes Motor Vehicle Registration Certificates Certified Risks - Financial Responsibility Laws Premium Calculation Rule Whole Dollar Premium Rule Installment Payment of Premiums Deposit Premium Rule Employers Subject to Massachusetts Workers Compensation Act Deductibles - s 7, 8 and Substitute Transportation Termination of Insurance Discounts and Credits Vehicle Liability Symbols Model Year Rating Non-Symbolled Vehicles and Rating Vehicles for which Symbols are not shown On the Rate Pages High-Theft Vehicles Extra-Risk Rating (Collision and Comprehensive) Vehicle Series Rating Additional Company Rating Rules Years Licensed Risk Factor Driver Vehicle Factor Loyalty Plus Factor HH Level Factor Hardship Accommodation Rule No. SECTION II - PRIVATE PASSENGER AUTOMOBILES 27 Private Passenger Definition Private Passenger Classifications Reserved For Future Use al Injury Protection - Deductible Form Transportation of Fellow Employees TC - 1

11 RULE 11. PREMIUM CALCULATION RULE The term MAIP premium below refers to MAIP Rates effective 10/1/13. Table A STEP Coverage s Total 1 Base Rate by Territory Code and Class 2 Limited Collision Factor x 3 Liability/Model Year Symbol Factor x x x x x x x x 4 Base Rate by Limit 5 Increased Limits Factor x x x x 6 Deductible Factor x x x x 7 Glass Deductible x 8 Waiver of Deductible + 9 Extra Risk Factor x x 10 Years Licensed Factor x x x x x x x x x x x x 11 Risk Factor x x x x x x x x x x x x 12 Driver to Vehicle (include deferred driver) Factor x x x x x x x x x x x x 13 Household Level Factor x x x x x x x x x x x x 14 Loyalty Plus Factor x x x x x x x x x x x x 15 Annual Mileage Discount x x x x x x x x x 16 Multi-Car Discount x x x x x x x 17 Anti-Theft Discount x 18 Account Discount x x x x x x x x x x x x 19 Shop Smart Credit Discount x x x x x x x x x x x x 20 Welcome Back Credit x x x x x x x x x x x x Table A STEP 1 Base Rate by Territory Code and Class 2 Limited Collision Factor 3 Liability/Model Year Symbol Factor 4 Base Rate by Limit 5 Increased Limits Factor 6 Deductible Factor 7 Glass Deductible 8 Waiver of Deductible 9 Extra Risk Factor 10 Years Licensed Factor 11 Risk Factor 12 Driver to Vehicle (include deferred driver) Factor 13 Household Level Factor 14 Loyalty Plus 15 Annual Mileage Discount 16 Multi-Car Discount 17 Anti-Theft Discount 18 Account Discount 19 Shop Smart Discount Covera 21 Group Discount x x x x x x x x x x x x 22 Good Student Discount x x x x x x x x x x x x 23 Student Away From Home Discount x x x x x x x x x x x x 24 Smart Driver Discount x x x x x x x x x x x x 25 Green Discount x x x x x x x x x x x x 26 Clean in Three Discount x x x x 27 Senior Discount x x x x x x x x x x x x 28 Merit Rating Adjustment Subtotal Coverage Package Capping Factor 31 Sumproduct of Step 29 and Step MAIP Premium for selected Coverages in Coverage Package 33 Capping Amount (Step 29)*min[(Step 32 divided by Step 31)-1,0]*(Step 30) 34 New Subtotal (Step 29+Step 33) 35 Auto Loan/Lease Coverage x x 36 Paid In Full Discount x x x x x x x x x x x x 37 Accident Forgiveness x x x x x x x x x x x x 38 Commerce Elite Package Endorsement + 39 Commerce Enhancer Package Endorsement + Coverage Premium Please note, for detailed calculation descriptions and factors within a step please see the specific sections of this manual. Deleted: 20 Group Discount and Affinity/Marketing nership Discount 21 Good Student Discount 22 Student Away From Home Discount 23 Smart Driver Discount 24 Green Discount 25 Clean in Three Discount 26 Senior Discount 27 Merit Rating Adjustment 28 Subtotal 29 Coverage Package Capping Factor 30 Sumproduct of Step 28 and Step MAIP Premium for selected Coverages in Coverage Packag Capping Amount (Step 28)*min[(Step 31 divided by Step ,0]*(Step 29) 33 New Subtotal (Step 28+Step 32) 34 Auto Loan/Lease Coverage 35 Paid In Full Discount 36 Accident Forgiveness 37 Commerce Elite Package Endorsement 38 Commerce Enhancer Package Endorsement Coverage 7

12 Explanation of Steps 28-33: MAIP Capping (compliance with DOI Bulletin ) In order to comply with the Massachusetts Division of Insurance Bulletin , Rating Steps as found in Table A of Rule 11 ensure that for the Coverage Package Premium not to Exceed MAIP Premium in Effect October 1, 2013 identified in Bulletin , Exhibit 1, Commerce will charge no more than the MAIP premium for private passenger type vehicles as defined in Rule 29. The MAIP Capping calculation does not apply to miscellaneous type vehicles, including antique motor cars, antique motorcycles, motorcycles (incl. motor scooters, mopeds and similar motor vehicles), trailers and motor homes/camper bodies. This procedure will be calculated as follows: Step 29: Derive the manually rated premium by applying Steps 1 through 27 in Table A as found in Rule 11. This will be referred to in future rating steps as Uncapped Premium Step 30: Determine the Coverage Package Capping Factor from Tables B.1 B.11, C, and D as found in Rule 11 applicable to each coverage based on the coverage limit selection for the rated vehicle. A factor equal to will reflect that the Coverage falls within the definition of Bulletin , Exhibit 1 and is subject to premium capping, a (zero) will reflect that the Coverage is not included within the definition of Bulletin , Exhibit 1 and is not subject to premium capping. Step 31: Multiply each Coverage s Uncapped Premium by the Coverage Package Capping Factor as determined in Step 30. Add all Coverage s together. This total will be called Applicable Capped Premium for the Rated Vehicle. Step 32: Determine the applicable MAIP Premium for all Coverage s where the Coverage Package Capping Factor, as determined in Step 30, equals Sum all of the Coverage s premium. This will be referred to in future rating steps as Applicable MAIP Premium Step 33: Determine the necessary Premium reduction for each Coverage using the formula: Step 29 * MINIMUM ( [ Step 32 Step 31 ] 1.00, 0.00 ) * Step 30 or in words: Uncapped Premium x MINIMUM of [ (A) Applicable MAIP Premium Applicable Capped Premium minus 1.00 ; (B) (zero) ] x Coverage Package Capping Factor Deleted: 28 Deleted: 33 Deleted: 2012 Deleted: 28 Deleted: 29 Deleted: 30 Deleted: 29 Deleted: 31 Deleted: 29 Deleted: 32 Deleted: 28 Deleted: 31 Deleted: 30 Deleted: 29 Note: This value will always be either a Negative Amount or Zero for each Coverage. Step 34: Step 29 + Step 33 Deleted: 33 Deleted: 28 Deleted: 32 8

13 Tables B.1 through B.11, C, and D RULE 12. PREMIUM ROUNDING RULE The premium for each exposure will be rounded, separately for each coverage provided by the policy, as follows: 1. Steps 1 through 26, as provided in Rule 11, will be rounded to the penny after each step. 2, Step 27, 28 and will be rounded to the nearest whole dollar, For whole dollar rounding, a premium involving $0.50 or more will be rounded to the next whole dollar at the end of each step. This does not apply to 5, 20/40 limits and 6, $5,000 limit where rates may be used or rounded to the lower whole dollar. This procedure will apply to all interim premium adjustments, including endorsements or cancellations at the request of the insured. In the case of cancellation by Commerce, the return premium will be carried to the next higher whole dollar. Deleted: 25 Deleted: 26 Deleted: 27 Deleted: 34 Deleted: 38 9

14 RULE 11. PREMIUM CALCULATION RULE The term MAIP premium below refers to MAIP Rates effective 10/1/13. Table A STEP Coverage s Total 1 Base Rate by Territory Code and Class 2 Limited Collision Factor x 3 Liability/Model Year Symbol Factor x x x x x x x x 4 Base Rate by Limit 5 Increased Limits Factor x x x x 6 Deductible Factor x x x x 7 Glass Deductible x 8 Waiver of Deductible + 9 Extra Risk Factor x x 10 Years Licensed Factor x x x x x x x x x x x x 11 Risk Factor x x x x x x x x x x x x 12 Driver to Vehicle (include deferred driver) Factor x x x x x x x x x x x x 13 Household Level Factor x x x x x x x x x x x x 14 Loyalty Plus Factor x x x x x x x x x x x x 15 Annual Mileage Discount x x x x x x x x x 16 Multi-Car Discount x x x x x x x 17 Anti-Theft Discount x 18 Account Discount x x x x x x x x x x x x 19 Shop Smart Credit x x x x x x x x x x x x 20 Welcome Back Credit x x x x x x x x x x x x 21 Group Discount x x x x x x x x x x x x 22 Good Student Discount x x x x x x x x x x x x 23 Student Away From Home Discount x x x x x x x x x x x x 24 Smart Driver Discount x x x x x x x x x x x x 25 Green Discount x x x x x x x x x x x x 26 Clean in Three Discount x x x x 27 Senior Discount x x x x x x x x x x x x 28 Merit Rating Adjustment Subtotal Coverage Package Capping Factor 31 Sumproduct of Step 29 and Step MAIP Premium for selected Coverages in Coverage Package 33 Capping Amount (Step 29)*min[(Step 32 divided by Step 31)-1,0]*(Step 30) 34 New Subtotal (Step 29+Step 33) 35 Auto Loan/Lease Coverage x x 36 Paid In Full Discount x x x x x x x x x x x x 37 Accident Forgiveness x x x x x x x x x x x x 38 Commerce Elite Package Endorsement + 39 Commerce Enhancer Package Endorsement + Coverage Premium Please note, for detailed calculation descriptions and factors within a step please see the specific sections of this manual. 7

15 Explanation of Steps 28-33: MAIP Capping (compliance with DOI Bulletin ) In order to comply with the Massachusetts Division of Insurance Bulletin , Rating Steps as found in Table A of Rule 11 ensure that for the Coverage Package Premium not to Exceed MAIP Premium in Effect October 1, 2013 identified in Bulletin , Exhibit 1, Commerce will charge no more than the MAIP premium for private passenger type vehicles as defined in Rule 29. The MAIP Capping calculation does not apply to miscellaneous type vehicles, including antique motor cars, antique motorcycles, motorcycles (incl. motor scooters, mopeds and similar motor vehicles), trailers and motor homes/camper bodies. This procedure will be calculated as follows: Step 29: Derive the manually rated premium by applying Steps 1 through 27 in Table A as found in Rule 11. This will be referred to in future rating steps as Uncapped Premium Step 30: Determine the Coverage Package Capping Factor from Tables B.1 B.11, C, and D as found in Rule 11 applicable to each coverage based on the coverage limit selection for the rated vehicle. A factor equal to will reflect that the Coverage falls within the definition of Bulletin , Exhibit 1 and is subject to premium capping, a (zero) will reflect that the Coverage is not included within the definition of Bulletin , Exhibit 1 and is not subject to premium capping. Step 31: Multiply each Coverage s Uncapped Premium by the Coverage Package Capping Factor as determined in Step 30. Add all Coverage s together. This total will be called Applicable Capped Premium for the Rated Vehicle. Step 32: Determine the applicable MAIP Premium for all Coverage s where the Coverage Package Capping Factor, as determined in Step 30, equals Sum all of the Coverage s premium. This will be referred to in future rating steps as Applicable MAIP Premium Step 33: Determine the necessary Premium reduction for each Coverage using the formula: Step 29 * MINIMUM ( [ Step 32 Step 31 ] 1.00, 0.00 ) * Step 30 or in words: Uncapped Premium x MINIMUM of [ (A) Applicable MAIP Premium Applicable Capped Premium minus 1.00 ; (B) (zero) ] x Coverage Package Capping Factor Note: This value will always be either a Negative Amount or Zero for each Coverage. Step 34: Step 29 + Step 33 8

16 Tables B.1 through B.11, C, and D RULE 12. PREMIUM ROUNDING RULE The premium for each exposure will be rounded, separately for each coverage provided by the policy, as follows: 1. Steps 1 through 26, as provided in Rule 11, will be rounded to the penny after each step. 2, Step 27, 28 and will be rounded to the nearest whole dollar, For whole dollar rounding, a premium involving $0.50 or more will be rounded to the next whole dollar at the end of each step. This does not apply to 5, 20/40 limits and 6, $5,000 limit where rates may be used or rounded to the lower whole dollar. This procedure will apply to all interim premium adjustments, including endorsements or cancellations at the request of the insured. In the case of cancellation by Commerce, the return premium will be carried to the next higher whole dollar. 9

17 RULE 19. DISCOUNTS and CREDITS A. Multi-Car Private Passenger Automobile An individual or lawfully married individuals residing in the same household, who own(s) two or more automobiles and purchases coverage from Commerce for at least two such automobiles, shall be entitled to a reduction of the premium applicable to Coverage s 1, 2, 4, 5, 7, 8 and 9. At least two of the automobiles must be private passenger vehicles as defined in Rule 27, except that vehicles classified as antiques are not eligible. Refer to Miscellaneous Rating Factors page for applicable discount. Motorcycle An individual or lawfully married individuals residing in the same household, who own(s) two or more automobiles with at least one motorcycle and purchases coverage from Commerce for at least two such automobiles and one motorcycle, shall be entitled to a reduction of the premium applicable to Coverage s 1, 2, 4, 5, 7, 8, and 9. At least two of the automobiles must be private passenger vehicles as defined in Rule 27, except that vehicles classified as antiques are not eligible. At least one of the automobiles must be motorcycles as defined in Rule 44. Refer to Miscellaneous Rating Factors page for applicable discount. B. Account Discount The Account Discount applies if a named insured: (1) purchases a al Automobile Insurance Policy from Commerce, (eligible policies must include vehicles of the private passenger type as defined in Rule 27, motorcycles, or motor homes/camper bodies as defined in Rule 39) and number (2) or (3) below are met. Vehicles classified as antiques, and miscellaneous motor vehicle types (with the exception of motor homes/camper bodies as defined in Rule 39) are not eligible. (2) maintains a Massachusetts Property Insurance Policy on their principal place of residence with Commerce or Citation, the FAIR Plan, or another eligible company. The property policy shall include a Homeowner, Condominium (not rented to others), or Renters policy, but shall not include a dwelling/fire only policy. (3) maintains a qualifying MAPFRE life insurance policy(ies). A qualifying MAPFRE life insurance policy is an active individual term life or individual whole life policy within the policyholder s account that is owned by the named insured or a related household member. (4) maintains a qualifying Commerce or Citation al Umbrella policy or endorsement If the above criteria are met: Only the largest single discount shall apply; anda discount of the premium applicable for Coverage s 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 will be given to eligible policyholders as follows: Description No MAPFRE Life Policy & No Commerce/ Citation Umbrella MAPFRE Life Policy (No Commerce/ Citation Umbrella) Commerce/ Citation Umbrella Policy (No life) Commerce/ Citation Umbrella Policy (Including MAPFRE Life) Commerce Auto only 0% 4% Commerce Auto and Home (HO 2, 3) Commerce Auto and Home (HO 15) % Commerce Auto and Home (HO 4, 6) 9% Property with the Fair Plan 4% 4% 6% Property with Other Carrier 7% 7% 9% C. Anti-Theft Device Refer to Anti-Theft Devices Standards and Discounts Section. 16

18 D. Class 15 Premiums otherwise applicable to class 10 automobiles shall be reduced by 2 for insureds age 65 or older. If the principal operator becomes age 65 during the policy year, the class 10 premium will be adjusted as of that date. The premium adjustment will be credited to the policyholder on that date unless that date is within sixty days of the expiration date of the policy, in which case the adjustment may be credited to the renewal policy. A notice of this classification change must be sent, or made electronically available to the policyholder either prior to or with the proposed adjustment. The policyholder is required to notify Commerce of any change in operator usage which would affect entitlement to the discount. The 2 discount is applied to the final premium for each part after all other discounts and rating factors have been completed. It is the last step in the rating process prior to the application of the premium adjustment required under the Merit Rating Plan. E. Annual Mileage Discount A discount of the premium paid for s 1, 2, 3, 4, 5, 6, 7, 8 and 12 will be given to eligible policyholders when the annual mileage of the vehicle falls into one of six categories. The discount will be based on: (1) the Years Licensed Group of the operator assigned to that vehicle, (2) the Premium Town Group of the operator assigned to that vehicle and (3) the actual mileage driven in a recent 12 month period as determined by a comparison of two odometer readings, at least six months apart, and not more than 24 months prior to renewal processing or, obtained from Registry of Motor Vehicle information, or (2) if not available, a certification by the insured on the Annual Mileage Discount Form or other paper or on-line forms required by the company. Refer to the Miscellaneous Rating Factors page for the applicable categories and discounts. Eligibility The vehicle must be a private passenger vehicle as defined in Rule 27, except that vehicles classified as antiques are not eligible. Commerce may request that the applicant for the discount complete the Annual Mileage Discount Form or other paper or on-line form for the verification of eligibility for the discount. If two odometer readings, at least six months apart are not available to Commerce through the Registry of Motor Vehicles as set forth above, or if the Annual Mileage Discount Form or other required form is not completed by the insured and provided to the company prior to renewal processing, the vehicle is not eligible for the annual mileage discount If a vehicle replaces another vehicle which is receiving the discount, the annual mileage of the prior vehicle will be attributed to the replacement vehicle. Application of Discount The applicable discount applies to rates otherwise determined for each insured vehicle by coverage, limits purchased, territory code, driver class, and model year and symbol prior to the application of the premium adjustment required under the Merit Rating Plan. F. Shop Smart Credit The Shop Smart Credit applies to new business policies provided the following criteria are met: 1. Eligible policyholders must have prior insurance with a company other than Commerce, for a minimum of 6 months; and Deleted: Discount Deleted: Discount 2. Eligible policyholders must have no prior lapse in coverage within the last 3 years. If the above two criteria are met and the policyholder has been at the same residence: (1) for 7 or more years; or (2) less than 7 years, and has a policy that was submitted to Commerce at least 7 days prior to the policy effective date, then the Shop Smart Credit will apply. In addition, an eligible policy must include vehicles of the private passenger type as defined in Rule 27, or motor homes/camper bodies as defined in Rule 39. Vehicles classified as antiques, motorcycles and miscellaneous motor vehicle types (with the exception of motor homes/camper bodies as defined in Rule 39) are not eligible to receive this discount. Deleted: discount 17

19 Exception: The Welcome Back and Shop Smart Credits are mutually exclusive. If the policy is elgible for the Welcome Back Credit, then the Shop Smart Credit will not apply. The Shop Smart Credit will continue to apply at the first and second renewal term following the first application of this credit. A discount of the premium applicable for Coverage s 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 will be given to eligible policyholders. Refer to the Miscellaneous Rating Factors page for applicable discount. Deleted: A Deleted: Discount Deleted: upon G. Good Student Discount The Good Student Discount applies provided the following criteria are met: a) The rated operator: 1. Is classified in one of the following inexperienced operator classes: 17, 18, 20, 21, 25 or 26; and 2. Is a full time high school, home study, college, or university student. b) The rated operator has met one of the following requirements: 1. Is in the upper 20% of his or her class scholastically; or 2. maintains a B average or higher, or its equivalent, or if the letter grading system cannot be averaged then no grade can be below a B ; or 3. in schools using numerical grade points, such as 4.0, 3.0, 2.0 and 1.0, had an average of at least 3.0 points or it s equivalent for all subjects combined; or 4. was included on the Dean s List, Honor Roll or comparable list indicating scholastic achievement. 5. In the case of home schooling, 2 options are given: I. a standardized form certified by a 3 rd party organization showing evidence that one of the qualifications listed above is satisfied; or II. evidence of scoring in the upper 20% on an annual national standardized exam. The discount will be applied to Coverage s 1, 2, 4, 5, 7, 8, and 9. Refer to the Miscellaneous Rating Factors page for applicable discount. The Good Student Discount cannot be applied in conjunction with the Student Away from Home discount. If the insured is eligible for both discounts, the Student Away from Home discount will apply. H. Student Away from Home Discount The Student Away from Home Discount applies provided the following criteria are met: a) The rated operator is classified in one of the following inexperienced operator classes: 17, 18, 20, 21, 25 or 26. b) The rated operator is a student residing at an educational institution over 100 road miles from the automobile s principal place of garaging. c) The student does not have regular access to the covered vehicle while at school. The discount will be applied to Coverage s 1, 2, 4, 5, 7, 8, and 9. Refer to the Miscellaneous Rating Factors page for applicable discount. The Student Away from Home discount can not be applied in conjunction with the Good Student discount. If the rated operator is eligible for both discounts, the Student Away from Home Discount will apply. I. Paid-in-Full Discount The Paid-in-Full Discount applies to policies where the annual policy premium is paid in full, subject to the following: For new business, payment must be made in full upon down payment. For renewal business, payment must be made in full upon the first installment due date. Exceptions: (1) National Standard and Named Non-owned policies are not eligible for the discount, and; (2) Finance company payments do not qualify for the discount. The discount will be applied to Coverage s 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12. Refer to the Miscellaneous Rating Factors page for applicable discount. 18

20 J. Smart Driver Discount A Smart Driver Discount will apply if an eligible rated operator has completed a company approved Advanced Driver Training Program or the teensmart Training Program. The following eligibility rules apply: 1) Vehicle must be a private passenger vehicle as defined in Rule 27. Vehicles classified as antiques, motorcycles, motor homes/campers and miscellaneous motor vehicle types are not eligible. 2) All operator classes are eligible for the discount when the Advanced Driver Training Program is completed. 3) Operator classes 17, 18, 20, 21, 25 & 26 only are eligible for the discount when the teensmart Training Program is completed. 4) Discount will apply for the 5 year period from when the course is completed. For teensmart only, the discount will apply for the 5 year period from when the course is completed or until the operator reaches class 10, whichever is earlier. The maximum allowable discount at any given time is, regardless of the number of training programs completed by an individual driver. The discount will be applied to Coverage s 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12. Refer to the Miscellaneous Rating Factors page for specific courses and their applicable discounts. K. Green Discount One of the following disounts will apply provided the following criteria are met: A. EFT/EBill only The EFT/EBill Discount will apply provided the following criterion is met: The insured is enrolled in either CIC s Electronic Fund Transfer program (EFT) or Electronic Invoice (EBill) program. B. Paperless (policy forms only) The Paperless Discount will apply provided the following criterion is met: The insured must sign up to view and receive their policy forms electronically on CWEB. C. EFT/EBill and Paperless The EFT/EBill and Paperless Discount will apply provided the following criteria are met: The insured is enrolled in either CIC s Electronic Fund Transfer program (EFT) or Electronic Invoice (EBill) program; and The insured must sign up to view and receive their policy forms electronically on CWEB. Exception: -National Standard and Named Non-owned policies are not eligible for the discount, - Policies with the Paid in Full Discount are not eligible for this discount under A or C, only B. The Paid in Full discount can only be applied in conjuction with Paperless (policy forms). The discount will be applied to Coverage s 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12. Refer to the Miscellaneous Rating Factors page for applicable discount. L. Clean in Three Discount The Clean in Three Discount will apply provided the following criteria are met: a.) The rated vehicle is subject to the Merit Rating Plan; b.) There are no at-fault accidents or traffic violations attributable to the rated operator during the three years immediately preceding the policy effective date; c.) The rated operator has been licensed for at least three years; and d.) An electronic copy of the rated operator s driving experience is made available to Commerce when the rated operator has prior driving experience outside of MA during the Merit Rating Experience Period. Exceptions: -The rated operator s Merit Rating points are 00, 98, or 99; -The rated operator s Merit Rating points are greater than or equal to 5; -The rated operator has one or more days lapse in coverage within the last 12 months. The discount will be applied to Coverage s 1, 2, 4, and 7. Refer to the Miscellaneous Rating Factors page for applicable discount. M. Welcome Back Credit The Welcome Back Credit will apply to new business policies, effective and subsequent, provided the following criteria are met: 19