LOUISIANA DEPARTMENT OF INSURANCE STATEMENT OF COMPLIANCE POLICY FORM / RATE / ADVERTISING FILING

LOUISIANA DEPARTMENT OF INSURANCE STATEMENT OF COMPLIANCE POLICY FORM / RATE / ADVERTISING FILING Insurer Name: Product Code: P0302-010000 NAIC #: Company Tracking #: Policy Holder Type: Filing Submission Date: The Certification of Compliance Form CANNOT BE FILED for this product type. Form Filing Requirements Description Form - Section / Page # La. R.S. 22: 1281 All automobile policies shall be written in language that can be easily understood by most automobile insurance consumers. La. R.S. 22: 860 A Warranties and misrepresentations by the insured made in the negotiation of a contract cannot be deemed material or void the contract unless such is made with the intent to deceive. La. R.S. 22: 864 B(1) A policy shall specify the names of the parties to the contract. The insurer's name and if not a life insurer, the type of organization shall be clearly shown in the policy. La. R.S. 22: 864 B(2) A policy shall specify the subject of the insurance. La. R.S. 22: 864 B(3) A policy shall specify the risks insured against. La. R.S. 22: 864 B(4) A policy shall specify the time at which the insurance thereunder takes effect and the period during which the insurance is to continue. 4/20/2018 page 1 of 13

La. R.S. 22: 864 B(5) A policy shall include a statement of the premium. If other than life, accident or health, or title insurance, the premium rate should also be specified. La. R.S. 22: 864 B(6) A policy shall specify the conditions pertaining to the insurance. La. R.S. 22: 864 B(8) Every printed portion of the text matter of the policy and of any endorsements or attached papers shall be printed in uniform, no less than ten-point type. The text matter shall include all printed matter except the name and address of the insurer, name or title of the policy, captions, sub-captions, and form numbers. La. R.S. 22: 864 B(9) Each policy form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of each page. La. R.S. 22: 869 Every insurance contract shall be executed in the name of and on behalf of the insurer by its officer, employee, or representative duly authorized by the insurer. A facsimile signature of any such executing officer, employee, or representative may be used in lieu of an original signature. La. R.S. 32: 900 D Motor Vehicle Policy Contents La. R.S. 32: 900 F La. R.S. 32: 900 H Every motor vehicle liability policy shall be subject to; no annulment of liability, a duty of the insurance carrier to make payment; right to settle claim by insurance carrier and the policy, application and any endorsement or riders shall constitute entire contract. Any motor vehicle liability policy may provide that the insured shall reimburse the insurance carrier for any payment the insurance carrier would not have been obligated to make under the terms of the policy except for the provisions of this Chapter. La. R.S. 32: 900 I LDI Dir 94:Dir 94 Any motor vehicle liability policy may provide for the prorating of the insurance thereunder with other valid and collectible insurance. Act 578 - House Bill 395-1989 Louisiana Regular Session - Cancellation f or nonfault incidents. "No insurer shall be able to increase the rate, increase or add a surcharge, cancel, or fail to renew any policy of motor vehicle insurance when such action is based on consideration of one or more nonfault incidents." 4/20/2018 page 2 of 13

LDI Dir 95:Dir 95 Acts 438 and 773 of the 1989 Louisiana Legislature - Temporary Substitute Vehicle. Schedules Description Form - Section / Page # La. R.S. 32: 900 B(1) Description of Covered Vehicles Form Filing Prohibitions Description Form - Section / Page # La. R.S. 22: 868 A(2) No insurance contract shall contain any condition, stipulation, or agreement depriving the courts of this state of the jurisdiction of action against the insurer. Definitions Description Form - Section / Page # La. R.S. 22: 1295 (2)(a) Uninsured motor vehicle includes an insured motor vehicle where the liability insurer is unable to make payment with respect to the legal liability of its insured within the limits specified therein because of insolvency. La. R.S. 22: 1295 (2)(b) Under-insured motorist is included in definition of Uninsured motorist. La. R.S. 45:201.4 TRANSPORTATION NETWORK COMPANY - Definitions Benefit / Coverage Provisions Description Form - Section / Page # La. R.S. 22: 1295 (1)(d) Unless the named insured has rejected uninsured motorist coverage, the insurer issuing an automobile liability policy that does not afford collision coverage for a vehicle insured thereunder shall, at the written request of a named insured, provide UMPD coverage in the amount of the actual cash value of such motor vehicle described in the policy or $25,000, subject to a deductible in an amount of two hundred fifty dollars for any one accident. Exceptions: where there is no physical contact; for loss of use; and for damages which are paid or payable under any other property insurance. 4/20/2018 page 3 of 13

Mandated Benefits / Provisions Description Form - Section / Page # La. R.S. 22: 1294 A Payment for Substitute Vehicle; notice of discontinuation. La. R.S. 22: 1296 Temporary substitute motor vehicles/ rental private passenger vehicles; extension of coverage; and priority of recoveries. La. R.S. 32: 900 B(2) Express or Implied Permission La. R.S. 32: 900 B(2)* Territory La. R.S. 32: 900 B(2)** Minimum financial limits; exclusive of interests and costs La. R.S. 32: 900 C Coverage for non-owned vehicles La. R.S. 45: 163 D Minimum financial responsibility - motor carriers La. R.S. 45: 173 Contract Carriers; Liability policy or bond required La. R.S. 45: 200.4 Insurance of each public carrier vehicle; Minimum financial responsibility. La. R.S. 45:201.6 TRANSPORTATION NETWORK COMPANY - Requirements for insurance 4/20/2018 page 4 of 13

Exclusions Description Form - Section / Page # La. R.S. 45:201.7 TRANSPORTATION NETWORK COMPANY - Automobile insurance provisions Limitations / Exclusions Description Form - Section / Page # La. R.S. 22: 1294 B The notice shall not be required when the insured has received the repaired vehicle. La. R.S. 22: 1294 C The notice shall not be required when the insured requests the discontinuance of the substitute vehicle. La. R.S. 22: 1295 (1)(c)(i) Limits of uninsured motorist coverage are not increased because of multiple vehicles covered under said policy. La. R.S. 22: 1295 (1)(e) Uninsured motorist coverage does not apply to bodily injury while occupying a motor vehicle owned by the insured if such motor vehicle is not described, or is not an otherwise covered vehicle. La. R.S. 22: 1295 (1)(f) Uninsured motorist bodily injury where there is no physical contact. La. R.S. 32: 900 E Motor Vehicle exclusions for Worker's Compensation LDI Advisory 01-01:Advisory 01-01 Use of Pollution Exclusions in Commercial Lines Policy Forms LDI Advisory 01-02:Advisory 01-02 Use of Mold Exclusions in Insurance Policy Forms 4/20/2018 page 5 of 13

LDI Advisory 97-01:Advisory 97-01 Use of Standard Pollution Exclusions; Commercial lines Discrimination Prohibitions Description Form - Section / Page # La. R.S. 22: 1964 (7)(i) With regard to automobile liability insurance, terminating or modifying coverage, or refusing to issue or refusing to renew any policy solely because the applicant or insured filed for bankruptcy. This Subparagraph shall not apply where the refusal to continue to insure is based upon nonpayment of premium. Benefit / Claim Payment Provisions Description Form - Section / Page # La. R.S. 22: 1294 D Guarantee of Payment for a substitute vehicle at the request of the insured. La. R.S. 22: 1295 (6) La. R.S. 22: 1891 Action to enforce a claim under the uninsured motorist provisions of an automobile liability policy; prima facie proof that the owner and operator of the vehicle involved did not have automobile liability insurance in effect on the date of the accident in question. A policy of automobile liability insurance which provides for medical payments coverage shall not limit the time period during which the insured is entitled to payment or reimbursement for medical expenses incurred as a result of injuries caused by a covered accident when the injuries are diagnosed within one year of the accident and are reported to the insurer within three years of the accident. LDI Dir 143:Dir 143 Aftermarket crash parts disclosure requirement 4/20/2018 page 6 of 13

Loss Conditions Description Form - Section / Page # La. R.S. 22: 1269 A No policy or contract of liability insurance shall be issued or delivered in this state, unless it contains provisions to the effect that the insolvency or bankruptcy of the insured shall not release the insurer from the payment of damages for injuries sustained or loss occasioned during the existence of the policy, and any judgment which may be rendered against the insured for which the insurer is liable which shall have become executory, shall be deemed prima facie evidence of the insolvency of the insured, and an action may thereafter be maintained within the terms and limits of the policy by the injured person, or his or her survivors or heirs against the insurer. La. R.S. 22: 1269 B(1) The injured person or his or her survivors or heirs, at their option, shall have a right of direct action against the insurer within the terms and limits of the policy. La. R.S. 22: 1269 D Direct action against insurer; to benefit all injured persons and their survivors. Duty to defend; to protect all injured persons and their survivors. Settlement Options Description Form - Section / Page # La. R.S. 22: 1295 (5) Non-binding arbitration allowed LDI Dir 186:Dir 186 Proper Use of Cost of Airbag in Determining Total Loss of Vehicle 4/20/2018 page 7 of 13

Subrogation / Right of Recovery Description Form - Section / Page # La. R.S. 22: 1295 (4) Rights of Recovery La. R.S. 22: 882 LDI Dir 175:Dir 175 Under any policy of insurance which authorizes the insured to waive the right of recovery of the insured against any party prior to loss without additional premium, the insured shall also be entitled to waive in writing after loss without invalidating the policy the right of recovery against any of the following: (1) Anyone insured under the same policy; (2) A corporation, partnership or other entity in which the insured owns stock or has a proprietary interest; (3) Anyone who owns stock or has a proprietary interest in the insured; (4) An employee or employer of the insured; (5) Anyone having an interest as owner, lessor or lessee of the insured premises or the premises on which the loss occurred and the employees, partners and stockholders of such owner, lessor or lessee; and (6) Any relative by blood or marriage of the insured. The insurer shall be entitled to recover from the insured any compensation received by the insured for such waiver after loss not to exceed the amount paid to the insured for such loss by the insurer. Subrogation Provisions The Commissioner will consider for approval language that clearly conveys to the insured that any right of recovery from third parties in the part of the insurer, whether by subrogation or reimbursement, is subordinate to the insured s right to be fully compensated for his damages; and that the insurer is obligated to share in legal expenses incurred. The Commissioner will not approve policy language that excludes and/or reduces coverage for expenses incurred as a result of treatment of injury or sickness caused by the fault of a third party. Cancellation / Termination Provisions La. R.S. 22: 1266 G La. R.S. 22: 1266 D(3)(a) La. R.S. 22: 1267 Description Form - Section / Page # Duty to disclose possible eligibility for automobile liability insurance through the automobile liability assigned risk plan. Payment of an initial, renewal, or installment insurance premium by the insured to an insurer or an insurance agent with a check or other negotiable instrument which is returned to the payee by the institution upon which it is drawn shall be deemed grounds for the insurer to cancel the binder or policy from the date the premium payment was due for the initial or renewal term. The cancellation provisions for commercial insurance, including commercial property, commercial auto, commercial multi-peril, workers' compensation, professional errors and omissions, and commercial liability policies, must comply with LRS 22: 1267. If your policy form has cancellation provisions, then give the form number and page number in the space provided. 4/20/2018 page 8 of 13

La. R.S. 22: 1267 C(1) La. R.S. 22: 1267 C(2)(a) La. R.S. 22: 1267 C(2)(b) La. R.S. 22: 1268 A La. R.S. 22: 885 La. R.S. 22: 887 A(2) If coverage has not been in effect for sixty days and the policy is not a renewal, cancellation shall be effected by mailing or delivering a written notice at least sixty days before the cancellation effective date, except in cases where cancellation is based on nonpayment of premium. Notice of cancellation based on nonpayment of premium shall be mailed or delivered at least ten days prior to the effective date of cancellation. After coverage has been in effect for more than sixty days or after the effective date of a renewal policy, no insurer shall cancel a policy unless the cancellation is based on at least one of the following reasons: nonpayment of premium; fraud or material misrepresentation by the insured; activities or omissions on the part of the insured which change or increase any hazard insured against; change in the risk which increases the risk of loss after insurance coverage has been issued or renewed; determination by the commissioner of insurance that the continuation of the policy would jeopardize a company's solvency or would place the insurer in violation of the insurance laws of this state or any other state; violation or breach by the insured of any policy terms or conditions; or such other reasons approved by the commissioner of insurance. A notice of cancellation of coverage shall be in writing, mailed or delivered to the first-named insured at the mailing address as shown on the policy. Notices of cancellation for reasons other than nonpayment of premium shall be mailed or delivered at least thirty days prior to the effective date of the cancellation; notices of cancellation for nonpayment of premium shall be mailed or delivered at least ten days prior to the effective date of cancellation. The notice shall state the effective date of the cancellation. The insurer shall provide the first-named insured with a written statement setting forth the reason for the cancellation where the insured requests such a statement in writing and the named insured agrees in writing to hold the insurer harmless from liability for any communication giving notice of or specifying the reasons for a cancellation or for any statement made in connection with an attempt to discover or verify the existence of conditions which would be a reason for cancellation. Any refund due an insured because of either cancellation, elimination, or reduction of coverage by the insurer or the insured, shall be accompanied with interest at the rate of one and one-half percent per month of the amount of the refund due the customer. Cancellation by the insured; surrender: Within 30 days following cancellation by the insured, the insurer shall pay the insured any unearned portion of any premium computed on a pro rata basis. An assessment of a monetary penalty by an insurer against an insured as a result of the insured s cancellation prior to the expiration of any policy is prohibited. Like notice must also be so delivered or mailed to each mortgagee, pledgee, or other known person shown by the policy to have an interest in any loss which may occur thereunder. La. R.S. 22: 887 D The portion of any premium paid to the insurer on account of the policy, including unearned commission, must be actually paid to the insured or other person entitled thereto as soon as practicable following such cancellation. 4/20/2018 page 9 of 13

Nonrenewal Provisions Description Form - Section / Page # La. R.S. 22: 1267 D(1) La. R.S. 22: 1267 D(2) An insurer may decide not to renew a policy if it delivers or mails written notice it will not renew the policy. Such notice of nonrenewal shall be mailed or delivered at least sixty days before the expiration date. Such notice to the insured shall include the insured's loss run information for the period the policy has been in force within, but not to exceed, the last three years of coverage. If the notice is mailed less than sixty days before expiration, coverage shall remain in effect under the same terms and conditions until sixty days after notice is mailed or delivered. Earned premium for any period of coverage that extends beyond the expiration date shall be considered pro rata based upon the previous year's rate. Notice of nonrenewal shall not be required if the insurer or a company within the same insurance group has offered to issue a renewal policy, or where the named insured has obtained replacement coverage or has agreed in writing to obtain replacement coverage. Premium Rating Requirements Description Form - Section / Page # La. R.S. 22: 1464 Rate Filing LDI Bltn 09-09:Bltn 09-09 Submittal of Consent-to-Rate Filings, A-Rated Filings and Individual Risk Related Filings Premium Rate Adjustment Description Form - Section / Page # La. R.S. 22: 1267 E(1) La. R.S. 22: 1267 E(2) An insurer shall mail or deliver to the named insured at the mailing address shown on the policy written notice of any rate increase, change in deductible, or reduction in limits or coverage at least thirty days prior to the expiration date of the policy. If the insurer fails to provide such thirty-day notice, the coverage provided to the named insured at the expiring policy's rate, terms, and conditions shall remain in effect until notice is given or until the effective date of replacement coverage obtained by the named insured, whichever first occurs. This Subsection shall not apply to the following: changes in a rate or plan filed with the insurance rating commission and applicable to an entire class of business; changes based upon the altered nature or extent of the risk insured; changes in policy forms filed and approved with the commissioner and applicable to an entire class of business; or changes requested by the insured. La. R.S. 22: 1284.1 No insurer shall increase the premium rate or increase or add a surcharge on any policy of motor vehicle insurance when such action is based solely on consideration of a voluntary lapse in coverage. 4/20/2018 page 10 of 13

La. R.S. 22: 1484 A (1) Limitations on additional premium for commercial and noncommercial property, casualty or liability insurance policy where there has been no material change. La. R.S. 22: 1484 A (2) Notice requirements for additional premium for commercial and noncommercial property, casualty or liability insurance policy where there has been a material change. La. R.S. 22: 1484 C Rate changes at renewal General / Standard Provisions Description Form - Section / Page # La. R.S. 22: 1282 A vehicle liability policy or uninsured motorist coverage shall not limit the coverage of the spouse or resident relative of a named insured, or permissive users. La. R.S. 22: 1291 The primary liability, physical damage, or collision coverage for a loaner vehicle shall be the policy of the driver, not the policy of the vehicle sales or service dealer who provided the loaner vehicle. La. R.S. 22: 1292 Towing and storage of motor vehicles; insurance policies; storage fees; exceptions. La. R.S. 22: 1295 (1)(a)(i) Uninsured motorist coverage; rejection/selection options; economic only uninsured motorist coverage. La. R.S. 22: 1295 (1)(a)(ii) La. R.S. 22: 1295 (1)(a)(iii) Prescribed UM form; named insured or his legal representative must sign; form is part of the policy whether physically attached or not; initial rejection valid for the life of the policy; insured may amend selection with new form; definition of new policy. Requirement for uninsured motorist coverage shall apply to any liability insurance covering any accident which occurs in this state and involves a resident of this state. La. R.S. 22: 1295 (1)(c )(ii) Priorities of recovery with respect to bodily injury to an injured party while occupying an automobile not owned by said injured party, resident spouse, or resident relative. 4/20/2018 page 11 of 13

LDI Advisory 09-03:Advisory 09-03 New Financial Responsibility Limits for Automobile Insurance - Effect on UM/UIM Motorist Bodily Injury Coverage Form Claim Filing Provisions Description Form - Section / Page # La. R.S. 22: 1264 Extension of proof of loss requirements in regards to a catastrophic event. La. R.S. 22: 1892 A(1) Payment required within 30 days after satisfactory proof of loss. La. R.S. 22: 1892 A(2) Third party claims must be paid within 30 days, after written agreement of settlement. La. R.S. 22: 1892 A(4) La. R.S. 22: 1892 B(4) La. R.S. 22: 1892 D All insurers shall make written offer to settle property damage claims within 30 days of receipt of proofs of loss. When property damage claim is on personal vehicle owned by third party claimant and as a direct consequence of the inactions of the insurer the third party claimant is deprived of use of the personal vehicle for more than five working days, the insurer responsible for payment of the claim shall pay for reasonable expenses incurred by the third party claimant in obtaining alternative transportation for the entire period of time during which the third party claimant is without the use of his personal vehicle. When making a payment incident to a claim, no insurer shall require that as a condition to such payment, repairs be made to a motor vehicle, including window glass repairs or replacement, in a particular place or shop or by a particular entity. Any insurer violating the provisions of this Subsection shall be fined not more than five hundred dollars for each offense. LDI Dir 34:Dir 34 Salvage on Paid Losses 4/20/2018 page 12 of 13

Application / Enrollment Form Description Form - Section / Page # La. R.S. 40: 1424(B) Required Fraud Statement. "Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison." 4/20/2018 page 13 of 13