SERFF Tracking #: GRAN State Tracking #: GRAN Company Tracking #: OH-PA-LT

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1 Product Name: Filing at a Glance Companies: Product Name: State: TOI: Sub-TOI: Filing Type: Grange Indemnity Insurance Company Trustgard Insurance Company Grange Mutual Casualty Company Grange Property & Casualty Insurance Company Ohio Private Passenger Auto (PPA) Form Date Submitted: 04/02/2013 SERFF Tr Num: SERFF Status: State Tr Num: State Status: Co Tr Num: Effective Date Requested (New): Effective Date Requested (Renewal): Author(s): Reviewer(s): GRAN Closed-FILED GRAN FILED OH-PA-LT /06/ /06/2013 Larry Tamasovich Trent Emig (primary) Disposition Date: 04/29/2013 Disposition Status: FILED Effective Date (New): 04/06/2013 Effective Date (Renewal): 04/06/2013

2 Product Name: General Information Project Name: New Look Declarations Page - HP Exstream Project Number: OH-PA-LT Reference Organization: Reference Title: Filing Status Changed: 04/29/2013 State Status Changed: 04/29/2013 Created By: Larry Tamasovich Corresponding Filing Tracking Number: State TOI: 19.0 Status of Filing in Domicile: Not Filed Domicile Status Comments: Reference Number: Advisory Org. Circular: Deemer Date: Submitted By: Larry Tamasovich State Sub-TOI: Private Passenger Auto (PPA) Filing Description: As permitted by the file and use regulations of the State of Ohio, this filing is being submitted to make a change to the Auto Policy Declarations Page used by the Companies listed in this filing. With this change, we are removing the column titled "Description" on page 1 of the Auto Policy Declarations Page. The material included in this column was only used to describe the body style or type of the covered vehicle. However, we found, based on customer feedback that some of the descriptions were causing confusion for our policyholders. Since the field was not used for anything else, we have decided to eliminate it. To the best of our knowledge, we certify the subject filing complies with Ohio insurance laws. Should you have any questions, please contact me by phone at or at Tamasovichl@grangeinsurance.com. Company and Contact Filing Contact Information Larry Tamasovich, Product Manager 671 S High Street Columbus, OH tamasovichl@grangeinsurance.com [Phone]

3 Product Name: Filing Company Information Grange Indemnity Insurance Company 671 S. High Street Columbus, OH (614) ext. [Phone] CoCode: Group Code: 267 Group Name: FEIN Number: State of Domicile: Ohio Company Type: State ID Number: Trustgard Insurance Company 671 S. High Street Columbus, OH (614) ext. [Phone] CoCode: Group Code: 267 Group Name: FEIN Number: State of Domicile: Ohio Company Type: State ID Number: Grange Mutual Casualty Company 671 S. High Street Columbus, OH (614) ext. [Phone] CoCode: Group Code: 267 Group Name: FEIN Number: State of Domicile: Ohio Company Type: State ID Number: Grange Property & Casualty Insurance Company 671 South High Street Columbus, OH (614) ext. [Phone] CoCode: Group Code: 267 Group Name: FEIN Number: State of Domicile: Ohio Company Type: P&C State ID Number: Filing Fees Fee Required? State Specific Yes Fee Amount: $ Retaliatory? Fee Explanation: Per Company: No Filing requires a fee of $50 per company. Four companies are included with this filing. Yes Company Amount Date Processed Transaction # Grange Indemnity Insurance Company $ /02/ Trustgard Insurance Company $ /02/ Grange Mutual Casualty Company $ /02/ Grange Property & Casualty Insurance Company $ /02/ Statistical Reporting Agent (AAIS, ISO, ISSI, NCIS, NISS, SFAA, etc) REQUIRED on NEW Programs or NEW Lines of Business: Not a new program or new line of business. MANDATORY FIELD: PUBLIC RECORD - Acknowledge that EVERYTHING in this filing will become Public Record per ORC (A) or ORC (A): Acknowledged IMPORTANT CHANGE -- EFT IS MANDATORY FOR ALL FILINGS SUBMITTED ON OR AFTER 01/01/2011. See Bulletin attached to our General Instructions in SERFF.: Filing submitted with EFT.

4 Product Name: Correspondence Summary Dispositions Status Created By Created On Date Submitted FILED Trent Emig 04/29/ /29/2013 Filing Notes Subject Note Type Created By Created On Date Submitted EFT ok Reviewer Note Valerie Baader 04/04/2013

5 Product Name: Disposition Disposition Date: 04/29/2013 Effective Date (New): 04/06/2013 Effective Date (Renewal): 04/06/2013 Status: FILED Comment: * * * * * * * * * * * * * * * * * * * * * * * * * * IMPORTANT CHANGE * * * * * * * * * * * * * * * * * * * * * * * * * * * * * EFT BECAME MANDATORY EFFECTIVE 01/01/2011 FOR ALL FILINGS SUBMITTED ON OR AFTER THAT DATE. See Bulletin attached to our General Instructions in SERFF. This filing, as submitted or as amended herein, is Approved under Chapter 3935, or Accepted under Chapter 3937, of the Ohio Revised Code. IMPORTANT NOTICE: Our records indicate the implementation of this filing on the Effective Date(s) shown herein. If the effective date(s) is/are incorrect or you need to revise the effective date(s), submit a Note to Reviewer through SERFF with the requested change. Rate data does NOT apply to filing. Overall Rate Information for Multiple Company Filings Overall Percentage Rate Indicated For This Filing 0.000% Overall Percentage Rate Impact For This Filing 0.000% Effect of Rate Filing-Written Premium Change For This Program $0 Effect of Rate Filing - Number of Policyholders Affected 0 Schedule Schedule Item Schedule Item Status Public Access Supporting Document Filing Requirements Summary - P&C Filed Yes Supporting Document Auto Policy Declarations Page Filed Yes Form Auto Policy Declarations Page Filed Yes

6 Product Name: Reviewer Note Created By: Valerie Baader on 04/04/ :51 AM Last Edited By: Filing Rules Migration Submitted On: 04/06/ :00 AM Subject: EFT ok Comments: x

7 Product Name: Form Schedule Item No. Schedule Item Status Form Name Form Number Edition Date Form Type Form Action Action Specific Data Readability Score Attachments 1 Filed 04/29/2013 Auto Policy Declarations Page DEC0001 ( ) DEC Replaced Previous Filing Number: GRAN ; GRAN ; GRAN ; GRAN Auto Dec Page - Final Copy.pdf Replaced Form DEC0001 (09- Number: 2011) 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

8 Policy Number: Policy Type: Reason Issued: Effective Date: Print Date: Named Insured and Address Auto Policy Declarations Page This is not a bill. Issued by: XXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXX Policy Effective Dates: to 12:01 a.m. ET at the address of the named insured as shown, and for additional six month periods if renewed, as provided in the policy. These declarations with policy provisions, applications, forms and endorsements, if any, complete the above numbered policy. Total Policy Premium Summary Your Auto policy includes coverage for the following: XXXXXXXXXXXXXXXXXX Year Make Model XXXXXXXXXXXXXXXXXX VIN Premium The total premium shown does not include any applicable billing fees. Total Policy Premium Total Premium if Paid In Full Got questions? We ve got answers. Policy Information: If you have any questions about your coverages or other ways to save with Grange, be sure to contact your agent, at. Claims Assistance: To report or check on a claim, or visit grangeinsurance.com. Billing Questions: To inquire about your bill or pay it, call or visit grangeinsurance.com. Discounts For a description of these discounts, please reference the Discounts applied to your policy section. Policy Discounts Driver Discounts DEC0001 (0-201 ) Page 1 of 2

9 Policy Number: Policy Type: Discounts (Continued) Vehicle Discounts Vehicle Coverages Coverage is provided where a premium is shown for the vehicle and coverage. The coverages listed below apply separately for each vehicle and are provided only where a premium or included is shown. The limit of liability applies separately for each vehicle. Where there are multiple vehicles on the policy, stacking of any limits of liability among the vehicles is not allowed. Additional Interests Coverages Limits of Liability Premium Part A - Liability Bodily Injury Property Damage Part B - Medical Payments Part C - Uninsured Motorists Bodily Injury Property Damage Underinsured Motorists Bodily Injury Part D - Damage to Your Auto Other Than Collision Collision Optional Coverages Each Person Deductible Each Accident Vehicle Premium Policy Forms Form # Edition Date Description End of Declarations Page Page 2 of 2

10 Product Name: Supporting Document Schedules Satisfied - Item: Comments: Attachment(s): Item Status: Filing Requirements Summary - P&C No attachment Filed Status Date: 04/29/2013 Satisfied - Item: Comments: Attachment(s): Item Status: Auto Policy Declarations Page The only change is made to page 1 of the Auto Policy Declarations Page. A draft copy of page 1 is attached. This draft uses the previously filed version with deleted material lined through. A final printed copy of the complete Auto Policy Declarations Page is attached under the Form Schedule tab Auto Dec Page - Draft Copy.pdf Filed Status Date: 04/29/2013

11 Brimfield Ins Agency Inc 1204 Tallmadge Road Kent, OH (330) brimfieldinsurance.com Policy Number: PA Policy Type: Reason Issued: New Business Effective Date: 12/14/2012 Print Date: 12/14/2012 Named Insured and Address Brian Reedy Carrie Reedy 3622 Stroup Rd Rootstown OH Auto Policy Declarations Page This is not a bill. Issued by: Grange Property & Casualty Ins. Co., A Grange Insurance Company 671 South High Street, Columbus, OH Policy Effective Dates: 12/14/2012 to 06/14/ :01 a.m. ET at the address of the named insured as shown, and for additional six month periods if renewed, as provided in the policy. These declarations with policy provisions, applications, forms and endorsements, if any, complete the above numbered policy. Total Policy Premium Summary Your Auto policy includes coverage for the following: Year Make Model Description VIN Premium 2004 GMC Sierra Large Pickup 1GTEC14T44Z $ GMC Acadia Large Utility 1GKLRMED2AJ $ The total premium shown does not include any applicable billing fees. Total Policy Premium $ Did You Know... Total Premium if Paid In Full $ You have qualified for Home Ownership, Insurance Score, Prompt Payer, Anti-Theft, and Passive Restraint Discount(s). Find out how you can save even more by contacting Brimfield Ins Agency Inc at (330) You can save $59.00 if you pay in full. Your revised total premium would be $ Got questions? We ve got answers. Policy Information: If you have any questions about your coverages or other ways to save with Grange, be sure to contact your agent, Brimfield Ins Agency Inc at (330) Claims Assistance: To report or check on a claim, call (800) or visit grangeinsurance.com. Billing Questions: To inquire about your bill or pay it, call (800) or visit grangeinsurance.com. Discounts For a description of these discounts, please reference the Discounts applied to your policy section. Policy Discounts Home Ownership, Insurance Score, and Prompt Payer DEC0001 ( ) Page 1 of 3