ELIGIBL. EXPERIEN CE or AUT O (A) PROPOSE TOTAL SUBMITTE. LM Response NO COMMENTS. GROUP NAME STREET ADDRESS City STATE ZIP
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1 AUT O (A) PROPOSE TOTAL ELIGIBL E PROPOS PROPOSE EXPERIEN CE or D NUMBE NUMBE ED D SUBMITTE HOM RATE Dev. EFFECTI CU, E,M, R IN R IN EFFECTI EFFECTIV AGENCY OR MKT. D YES OR GROUP NAME STREET ADDRESS City STATE ZIP E (H) (%) VE DATE GROUP TYPE GROUP GROUP VE DATE E DATE REP. NO COMMENTS Anderson University Alumni 1100 East Fifth Street Anderson IN A M 35, Clara Knarr Liberty Mutual Insurance Company Association % No Liberty Mutual Insurance Company Champlain Cable Corporation 175 Hercules Drive Colchester VT A 5% E Jessica Simpson No Liberty Mutual Insurance Company North Dakota State University Alumni Association 1241 University Dr. North Fargo ND A 8% M 74, Leslie Rolison No Liberty Mutual Insurance Company North Shore Christian School 26 Urban Street Lynn MA A 8% E Jared Yagjian No Liberty Mutual Insurance Company Omgeo LLC 1140 Boylston Street Boston MA A 5% E Paul Hackley No Liberty Mutual Insurance Company Onforce, Inc. 10 Maguire Rd Blding 2 Lexington MA A 5% E Kevin Good No Liberty Mutual Insurance Company Ophir Optics, LLC 1600 Osgood St. N. Andover MA A 5% E Michael Wolfson No Liberty Mutual Insurance Company Segue Manufacturing Services, LLC 70 IndustrialAve. East Lowell MA A 5% E Catherine Driscoll No Liberty Mutual Insurance Company Somerville Municipal Federal Credit Union 236 HOLLAND ST SOMERVILLE MA A 5% CU 3,077 2,498 PaulKiersnowski No Liberty Mutual Insurance Company South Dakota State University Alumni Association Tompkins Alumni Center, Box 515, 905 Medary Ave. Brookings SD A 8% M 80, Leslie Rolison No Liberty Mutual Insurance Company Town of Maynard 195 Main St Maynard MA A 5% E Paul West No Liberty Mutual Insurance Company Town of Plainville 142 South St Plainville MA A 5% E Bill McDonough No Liberty Mutual Insurance Company Western New England College 1215 Wilbraham Rd Cambridge MA A 8% E Paul Hackley No LM Response Page 1
2 2011 EXPENSE EXHIBIT FOR ALL 193R GROUP MARKETING PLANS Insurers are required to submit the expense ratios underlying their current rates and the expense ratio or average expense per vehicle associated with the group marketing plan (1) (2) (3) (4) Expenses Assumed Expenses Associated Reasons for Requested INSURANCE In Insurer's Rates With Group Marketing Expensed Group Rate COMPANY GROUPNAME Currently On File* Plan Difference Deviation Liberty Mutual Insurance Company Anderson University Alumni Association 29.00% Liberty Mutual Insurance Company Champlain Cable Corporation 29.00% Liberty Mutual Insurance Company North Dakota State University Alumni Association 29.00% Liberty Mutual Insurance Company North Shore Christian School 29.00% Liberty Mutual Insurance Company Omgeo LLC 29.00% Liberty Mutual Insurance Company Onforce, Inc % Liberty Mutual Insurance Company Ophir Optics, LLC 29.00% Liberty Mutual Insurance Company Segue Manufacturing Services, LLC 29.00% 24.0% Payment, Reduced Marketing Costs 5% Liberty Mutual Insurance Company Somerville Municipal Federal Credit Union 29.00% Liberty Mutual Insurance Company South Dakota State University Alumni Association 29.00% Liberty Mutual Insurance Company Town of Maynard 29.00% Liberty Mutual Insurance Company Town of Plainville 29.00% Liberty Mutual Insurance Company Western New England College 29.00% * Expense ratio shown for non group business
3 MASSACHUSETTS 2011 GROUP MARKETING NEW/RENEWAL AFFIDAVIT Attached is the documentation required for the application for the listed Liberty Mutual Group 2011 Group Marketing clients. We have verified that it is the intention of each of the following clients to participate in the Group Marketing program within their organization for the year 2011 and have confirmed their participation to them in writing: Anderson University Alumni Association Champlain Cable Corporation North Dakota State University Alumni Association North Shore Christian School Omgeo LLC Onforce, Inc. Ophir Optics, LLC Segue Manufacturing Services, LLC Somerville Municipal Federal Credit Union South Dakota State University Alumni Association Town of Maynard Town of Plainville Western New England College You may contact any of our clients to verify information and confirm participation. Kaitlyn C. Faria
4 AUTO (A) or PROPOSED TOTAL NUMBER ELIGIBLE OF ORIGINAL EXPERIENCE HOME RATE Dev. EFFECTIVE CU, E,M, NUMBER NUMBER CURRENT PLAN AGENCY OR MKT. SUBMITTED GROUP NAME STREET ADDRESS City STATE ZIP (H) (%) DATE GROUP TYPE IN GROUP IN GROUP INSUREDS DATE REP. YES OR NO Anderson University Alumni 1100 East Fifth Street Anderson IN A M 35, Clara Knarr No Liberty Mutual Insurance Company Association % Liberty Mutual Insurance Company Champlain Cable Corporation 175 Hercules Drive Colchester VT A 5% E Jessica Simpson No Liberty Mutual Insurance Company North Dakota State University Alumni Association 1241 University Dr. North Fargo ND A 8% M 74, Leslie Rolison No Liberty Mutual Insurance Company North Shore Christian School 26 Urban Street Lynn MA A 5% E Jared Yagjian No Liberty Mutual Insurance Company Omgeo LLC 1140 Boylston Street Boston MA A 5% E Paul Hackley No Liberty Mutual Insurance Company Onforce, Inc. 10 Maguire Rd Blding 2 Lexington MA A 5% E Kevin Good No Liberty Mutual Insurance Company Ophir Optics, LLC 1600 Osgood St. N. Andover MA A 5% E Michael Wolfson No Liberty Mutual Insurance Company Segue Manufacturing Services, LLC 70 IndustrialAve. East Lowell MA A 5% E Catherine Driscoll No Liberty Mutual Insurance Company Somerville Municipal Federal Credit Union 236 HOLLAND ST SOMERVILLE MA A 5% CU 3,077 2,498 0 PaulKiersnowski No Liberty Mutual Insurance Company South Dakota State University Alumni Association Tompkins Alumni Center, Box 515, 905 Medary Ave. Brookings SD A 8% M 80, Leslie Rolison No Liberty Mutual Insurance Company Town of Maynard 195 Main St Maynard MA A 5% E Paul West No Liberty Mutual Insurance Company Town of Plainville 142 South St Plainville MA A 5% E Bill McDonough No Liberty Mutual Insurance Company Western New England College 1215 Wilbraham Rd Cambridge MA A 8% E Paul Hackley No COMMENTS LM Response Page 1
5 2011 EXPENSE EXHIBIT FOR ALL 193R GROUP MARKETING PLANS Insurers are required to submit the expense ratios underlying their current rates and the expense ratio or average expense per vehicle associated with the group marketing plan (1) (2) (3) (4) Expenses Assumed Expenses Associated Reasons for Requested INSURANCE In Insurer's Rates With Group Marketing Expensed Group Rate COMPANY GROUPNAME Currently On File* Plan Difference Deviation Liberty Mutual Insurance Company Anderson University Alumni Association 29.00% Liberty Mutual Insurance Company Champlain Cable Corporation 29.00% Liberty Mutual Insurance Company North Dakota State University Alumni Association 29.00% Liberty Mutual Insurance Company North Shore Christian School 29.00% Liberty Mutual Insurance Company Omgeo LLC 29.00% Liberty Mutual Insurance Company Onforce, Inc % Liberty Mutual Insurance Company Ophir Optics, LLC 29.00% Liberty Mutual Insurance Company Segue Manufacturing Services, LLC 29.00% 24.0% Payment, Reduced Marketing Costs 5% Liberty Mutual Insurance Company Somerville Municipal Federal Credit Union 29.00% Liberty Mutual Insurance Company South Dakota State University Alumni Association 29.00% Liberty Mutual Insurance Company Town of Maynard 29.00% Liberty Mutual Insurance Company Town of Plainville 29.00% Liberty Mutual Insurance Company Western New England College 29.00% * Expense ratio shown for non group business
6 AUT O (A) PROPOSE TOTAL ELIGIBL E PROPOS PROPOSE EXPERIEN CE or D NUMBE NUMBE ED D SUBMITTE HOM RATE Dev. EFFECTI CU, E,M, R IN R IN EFFECTI EFFECTIV AGENCY OR MKT. D YES OR GROUP NAME STREET ADDRESS City STATE ZIP E (H) (%) VE DATE GROUP TYPE GROUP GROUP VE DATE E DATE REP. NO COMMENTS Accountants World LLC 140 Fell Court Hauppauge NY A M 65,000 2,000 Joseph Liberty Mutual Insurance Company % Picone No Liberty Mutual Insurance Company American Quarter Horse Association 1600 Quarter Horse Drive Amarillo TX A 5% M 278, Lyndsay Lovell No Liberty Mutual Insurance Company Anderson University Alumni Association 1100 East Fifth Street Anderson IN A 8% M 35, Clara Knarr No Liberty Mutual Insurance Company Champlain Cable Corporation 175 Hercules Drive Colchester VT A 5% E Jessica Simpson No Liberty Mutual Insurance Company North Dakota State University Alumni Association 1241 University Dr. North Fargo ND A 8% M 74, Leslie Rolison No Liberty Mutual Insurance Company North Shore Christian School 26 Urban Street Lynn MA A 5% E Jared Yagjian No Liberty Mutual Insurance Company Omgeo LLC 1140 Boylston Street Boston MA A 5% E Paul Hackley No Liberty Mutual Insurance Company Onforce, Inc. 10 Maguire Rd Blding 2 Lexington MA A 5% E Kevin Good No Liberty Mutual Insurance Company Ophir Optics, LLC 1600 Osgood St. N. Andover MA A 5% E Michael Wolfson No Liberty Mutual Insurance Company Segue Manufacturing Services, LLC 70 IndustrialAve. East Lowell MA A 5% E Catherine Driscoll No Liberty Mutual Insurance Company Somerville Municipal Federal Credit Union 236 HOLLAND ST SOMERVILLE MA A 5% CU 3,077 2,498 PaulKiersnowski No Liberty Mutual Insurance Company South Dakota State University Alumni Association Tompkins Alumni Center, Box 515, 905 Medary Ave. Brookings SD A 8% M 80, Leslie Rolison No Liberty Mutual Insurance Company Town of Maynard 195 Main St Maynard MA A 5% E Paul West No Liberty Mutual Insurance Company Town of Plainville 142 South St Plainville MA A 5% E Bill McDonough No Liberty Mutual Insurance Company Western New England College 1215 Wilbraham Rd Cambridge MA A 8% E Paul Hackley No LM Response Page 1
7 2011 EXPENSE EXHIBIT FOR ALL 193R GROUP MARKETING PLANS Insurers are required to submit the expense ratios underlying their current rates and the expense ratio or average expense per vehicle associated with the group marketing plan (1) (2) (3) (4) Expenses Assumed Expenses Associated Reasons for Requested INSURANCE In Insurer's Rates With Group Marketing Expensed Group Rate COMPANY GROUPNAME Currently On File* Plan Difference Deviation Liberty Mutual Insurance Company Accountants World LLC 29.00% 19.0% Payment, Reduced Marketing Costs 5% Liberty Mutual Insurance Company American Quarter Horse Association 29.00% 19.0% Payment, Reduced Marketing Costs 5% Liberty Mutual Insurance Company Anderson University Alumni Association 29.00% Liberty Mutual Insurance Company Champlain Cable Corporation 29.00% Liberty Mutual Insurance Company North Dakota State University Alumni Association 29.00% Liberty Mutual Insurance Company North Shore Christian School 29.00% Liberty Mutual Insurance Company Omgeo LLC 29.00% Liberty Mutual Insurance Company Onforce, Inc % Liberty Mutual Insurance Company Ophir Optics, LLC 29.00% Liberty Mutual Insurance Company Segue Manufacturing Services, LLC 29.00% 24.0% Payment, Reduced Marketing Costs 5% Liberty Mutual Insurance Company Somerville Municipal Federal Credit Union 29.00% Liberty Mutual Insurance Company South Dakota State University Alumni Association 29.00% Liberty Mutual Insurance Company Town of Maynard 29.00% Liberty Mutual Insurance Company Town of Plainville 29.00% Liberty Mutual Insurance Company Western New England College 29.00% * Expense ratio shown for non group business
8 MASSACHUSETTS 2011 GROUP MARKETING NEW/RENEWAL AFFIDAVIT Attached is the documentation required for the application for the listed Liberty Mutual Group 2011 Group Marketing clients. We have verified that it is the intention of each of the following clients to participate in the Group Marketing program within their organization for the year 2011 and have confirmed their participation to them in writing: Accountants World LLC American Quarter Horse Association Anderson University Alumni Association Champlain Cable Corporation North Dakota State University Alumni Association North Shore Christian School Omgeo LLC Onforce, Inc. Ophir Optics, LLC Segue Manufacturing Services, LLC Somerville Municipal Federal Credit Union South Dakota State University Alumni Association Town of Maynard Town of Plainville Western New England College You may contact any of our clients to verify information and confirm participation. Kaitlyn C. Faria
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