filing at a glance - am best€¦ · greenwich insurance company and xl insurance america, inc. are...

Filing at a Glance Companies: Greenwich Insurance Company

XL Insurance America, Inc.

Product Name: ISO Company Exception - NA Programs

State: Louisiana

TOI: 01.0 Property

Sub-TOI: 01.0001 Commercial Property (Fire and Allied Lines)

Filing Type: Form

Date Submitted: 11/05/2015

SERFF Tr Num: XLAM-130240359

SERFF Status: Closed-Approved

State Tr Num: 331033

State Status: Approved

Co Tr Num: 15MX-XP-CP02-MU-LA-F

Effective DateRequested (New):

On Approval

Effective DateRequested (Renewal):

On Approval

Author(s): Jill Kelly

Reviewer(s): Bernadette Williams (primary)

Disposition Date: 11/20/2015

Disposition Status: Approved

Effective Date (New): 11/20/2015

Effective Date (Renewal): 11/20/2015

SERFF Tracking #: XLAM-130240359 State Tracking #: 331033 Company Tracking #: 15MX-XP-CP02-MU-LA-F

State: Louisiana First Filing Company: Greenwich Insurance Company, ...

TOI/Sub-TOI: 01.0 Property/01.0001 Commercial Property (Fire and Allied Lines)


Project Name/Number: Flood Coverage/15MX-XP-CP02-MU-LA-F

PDF Pipeline for SERFF Tracking Number XLAM-130240359 Generated 11/23/2015 06:36 AM

General Information

Company and Contact

Filing Fees

Project Name: Flood Coverage Status of Filing in Domicile: Pending

Project Number: 15MX-XP-CP02-MU-LA-F Domicile Status Comments:

Reference Organization: Reference Number:

Reference Title: Advisory Org. Circular:

Filing Status Changed: 11/20/2015

State Status Changed: 11/20/2015 Deemer Date:

Created By: Jill Kelly Submitted By: Jill Kelly

Corresponding Filing Tracking Number: 15MX-XP-CP02-MU-LA-R

State TOI: 01.0 Property State Sub-TOI: 01.0001 Commercial Property (Fire and AlliedLines)

Filing Description:

Greenwich Insurance Company and XL Insurance America, Inc. are filing a Flood Coverage Endorsement (GXIP 406 0815)and corresponding rule page (XLP-XL-FLOOD COVERAGE-MU 0815) for our North American Programs division's use. Thisform and rule page will be used with ISO's Building & Personal Property form CP 00 10 and Special Form Causes of Loss (CP10 30).

Filing Contact InformationJill Kelly, State Filings Analyst [email protected]

505 Eagleview Blvd.

Exton, PA 19341

610-968-9069 [Phone]

Filing Company InformationGreenwich Insurance Company

505 Eagleview Blvd.

Suite 100

Exton, PA 19341-0636

(800) 327-1414 ext. [Phone]

CoCode: 22322

Group Code: 1285

Group Name:

FEIN Number: 95-1479095

State of Domicile: Delaware

Company Type:

State ID Number:

XL Insurance America, Inc.

505 Eagleview Blvd.

Suite 100

Exton, PA 19341-0636

(800) 327-1414 ext. [Phone]

CoCode: 24554

Group Code: 1285

Group Name:

FEIN Number: 75-6017952

State of Domicile: Delaware

Company Type:

State ID Number:

Fee Required? Yes

Fee Amount: $50.00

Retaliatory? No

Fee Explanation:







Per Company: Yes

Company Amount Date Processed Transaction #Greenwich Insurance Company $25.00 11/05/2015 102373561XL Insurance America, Inc. $25.00 11/05/2015 102373459







Correspondence Summary DispositionsStatus Created By Created On Date SubmittedApproved Bernadette Williams 11/20/2015 11/20/2015

AmendmentsSchedule Schedule Item Name Created By Created On Date SubmittedSupportingDocument

Statement of Compliance (P&C Forms) Jill Kelly 11/16/2015 11/16/2015

SupportingDocument

Statement of Compliance (P&C Forms) Jill Kelly 11/16/2015 11/16/2015

Filing NotesSubject Note Type Created By Created On Date SubmittedStatement of Compliance Note To Filer Bernadette Williams 11/16/2015 11/16/2015







Disposition

Disposition Date: 11/20/2015

Effective Date (New): 11/20/2015

Effective Date (Renewal): 11/20/2015

Status: Approved

Comment:The Louisiana Department of Insurance approves the form(s) you submitted in the referenced filing, with any applicable substitutions and/or corrections.

If you submitted a rate/rule filing in conjunction with this form filing, the Rating Division of the Office of Property and Casualty will notify you of the rate/rule approval ordisapproval.

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 AccessSupporting Document Explanatory Memorandum-P&C Receipt Acknowledged Yes

Supporting Document Filing Fee - Form Filings Only Receipt Acknowledged Yes

Supporting Document (revised) Statement of Compliance (P&C Forms) Receipt Acknowledged Yes

Supporting Document Statement of Compliance (P&C Forms) Receipt Acknowledged Yes

Supporting Document Statement of Compliance (P&C Forms) Receipt Acknowledged Yes

Form Flood Coverage Endorsement Approved Yes







Amendment Letter

Submitted Date: 11/16/2015

Comments:

Attached is the current Statement of Compliance. Please disregard previous version submitted today.

Changed Items: No Form Schedule Items Changed.

No Rate Schedule Items Changed.

Supporting Document Schedule Item ChangesSatisfied - Item: Statement of Compliance (P&C Forms)Comments:Attachment(s): LA - Commercial Property Statement of Compliance.pdfPrevious VersionSatisfied - Item: Statement of Compliance (P&C Forms)Comments:Attachment(s): LA - Commercial Property Statement of Compliance.pdfPrevious VersionSatisfied - Item: Statement of Compliance (P&C Forms)Comments:Attachment(s): LA - Comm Property Statement of Compliance F.pdf







Amendment Letter

Submitted Date: 11/16/2015

Comments:

Attached is the current Statement of Compliance.

Changed Items: No Form Schedule Items Changed.

No Rate Schedule Items Changed.

Supporting Document Schedule Item ChangesSatisfied - Item: Statement of Compliance (P&C Forms)Comments:Attachment(s): LA - Commercial Property Statement of Compliance.pdfPrevious VersionSatisfied - Item: Statement of Compliance (P&C Forms)Comments:Attachment(s): LA - Comm Property Statement of Compliance F.pdf







Note To Filer

Created By:

Bernadette Williams on 11/16/2015 09:46 AM

Last Edited By:

Bernadette Williams

Submitted On:

11/20/2015 07:39 AM

Subject:

Statement of Compliance

Comments:

Please send current Statement of Compliance. Thank you.







Form Schedule

Item

No.

Schedule Item

Status

Form

Name

Form

Number

Edition

Date

Form

Type

Form

Action

Action Specific

Data

Readability

Score Attachments1 Approved

11/20/2015Flood CoverageEndorsement

GXIP 406 0815 END New 0.000 GXIP 4060815.pdf

Form Type Legend:ABE Application/Binder/Enrollment ADV Advertising

BND Bond CER Certificate

CNR Canc/NonRen Notice DEC Declarations/Schedule

DSC Disclosure/Notice END Endorsement/Amendment/Conditions

ERS Election/Rejection/Supplemental Applications OTH Other







Supporting Document Schedules Satisfied - Item: Explanatory Memorandum-P&CComments:

Attachment(s): EXPLANATORY MEMORANDUM.pdfForms Directory - Flood Endt.pdf

Item Status: Receipt AcknowledgedStatus Date: 11/20/2015

Satisfied - Item: Filing Fee - Form Filings OnlyComments: Fees submitted via EFTAttachment(s):Item Status: Receipt AcknowledgedStatus Date: 11/20/2015

Satisfied - Item: Statement of Compliance (P&C Forms)Comments:Attachment(s): LA - Commercial Property Statement of Compliance.pdfItem Status: Receipt AcknowledgedStatus Date: 11/20/2015







Superseded Schedule Items Please note that all items on the following pages are items, which have been replaced by a newer version. The newest version is located with the appropriate scheduleon previous pages. These items are in date order with most recent first.

Creation Date

Schedule Item

Status Schedule Schedule Item Name

Replacement

Creation Date Attached Document(s)11/16/2015 Receipt

Acknowledged11/20/2015

SupportingDocument

Statement of Compliance (P&C Forms) 11/16/2015 LA - Commercial Property Statementof Compliance.pdf (Superceded)

09/10/2015 ReceiptAcknowledged11/20/2015

SupportingDocument

Statement of Compliance (P&C Forms) 11/16/2015 LA - Comm Property Statement ofCompliance F.pdf (Superceded)







GXIP 406 0815 © 2015 X.L. America, Inc. All Rights Reserved. Page 1 of 5 May not be copied without permission.

Includes copyrighted material of Insurance Services Office, Inc. with its permission.

ENDORSEMENT # This endorsement, effective 12:01 a.m., forms a part of Policy No. issued to by . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

FLOOD COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM – CP 00 10 CAUSES OF LOSS – SPECIAL FORM – CP 10 30 Covered Location(s): Flood Limit Of Insurance: $<SELECT ONE> (Per Occurrence and Annual Aggregate Limit). Flood Deductible: $25,000 or as specified $ . The total amount payable in any one occurrence shall not exceed the Flood Limit of Insurance specified above regardless of the number of locations insured. A. This endorsement applies to the Covered Property at the Covered Location(s) specified above. B. Additional Covered Cause Of Loss

The following is added to the Covered Causes of Loss: Flood, meaning a general and temporary condition of partial or complete inundation of normally dry land areas due to: 1. The overflow of inland or tidal waters; 2. The unusual or rapid accumulation or runoff of surface waters from any source; or 3. Mudslides or mudflows which are caused by flooding as defined in B.2. above. For the purpose of

this Covered Cause of Loss, a mudslide or mudflow involves a river of liquid and flowing mud on the surface of normally dry land areas as when earth is carried by a current of water and deposited along the path of the current.

All flooding in a continuous or protracted event will constitute a single flood.

C. Exclusions, Limitations And Related Provisions 1. The Exclusions and Limitations sections of the Causes Of Loss form apply to coverage provided

under this endorsement except as provided in C.2. and C.3. below. 2. To the extent that a part of the Water Exclusion might conflict with coverage provided under this

endorsement, that part of the Water Exclusion does not apply.



3. To the extent that a tsunami causes the overflow of tidal waters, the exclusion of earthquake, in the Earth Movement Exclusion, does not apply.

4. The Ordinance Or Law Exclusion in this Coverage Form continues to apply with respect to any

loss under this Coverage Form including any loss under this endorsement, unless Ordinance Or Law Coverage is added by endorsement.

5. The following exclusions and limitations are added and apply to coverage under this endorsement:

a. We will not pay for any loss or damage caused by or resulting from any Flood that begins

before or within 72 hours after the inception date of this endorsement. However, this limitation does not apply to a particular location if Flood coverage was in effect for that location for at least 72 hours immediately prior to the inception date of this endorsement, under a policy issued by us or by another insurer, and this policy replaces the previous policy without a lapse in coverage. If you request and we provide an increase in the stated Limit of Insurance for Flood during the term of this policy, with the exception of an increase at the time of renewal of the policy, the increase will not apply to loss or damage from any Flood that begins before or within 72 hours after your request was made.

If the Flood is due to the overflow of inland or tidal waters, then the Flood is considered to begin when the water first overflows its banks.

b. We will not pay for loss or damage caused by or resulting from destabilization of land

arising from the accumulation of water in subsurface land areas. c. Under this Flood Coverage Endorsement, as set forth under Property Not Covered in the

Coverage Form to which this endorsement is attached, land is not covered property, nor is the cost of excavations, grading, backfilling or filling. Therefore, coverage under this endorsement does not include the cost of restoring or remediating land due to the collapse or sinking of land caused by or resulting from Flood. However, coverage under this endorsement includes damage to the covered portions of the building and to covered personal property, caused by collapse or sinking of land along the shore of a body of water as the result of erosion or undermining caused by waves or currents of water which exceed the cyclical levels and cause Flood.

d. We do not cover loss or damage by Flood to personal property in the open. e. Property Not Covered, in the Coverage Form to which this endorsement is attached, is

amended and supplemented as follows with respect to Flood Coverage: (1) Property Not Covered includes any building or other property that is not eligible for

flood insurance pursuant to the provisions of the Coastal Barrier Resources Act, 16 U.S.C. 3501 et seq. and the Coastal Barrier Improvement Act of 1990, Pub. L. 101-591, 16 U.S.C. 3501 et seq.

(2) Property Not Covered includes boat houses and open structures, and any property

in or on the foregoing, if the structure is located on or over a body of water. (3) If bulkheads, pilings, piers, wharves, docks, or retaining walls that are not part of a

building, have been removed from Property Not Covered and added as Covered Property by separate endorsement, this Flood Coverage Endorsement does not apply to such property.



(4) The following are removed from Property Not Covered and are therefore Covered Property: (a) Foundations below the lowest basement floor or the subsurface of the

ground; and (b) Underground pipes, flues and drains.

f. We will not pay for loss or damage caused by discharge of water or waterborne material

from a sewer, drain or sump unless such discharge results from Flood and occurs within 72 hours after the Flood recedes.

D. Additional Coverages And Coverage Extensions

With respect to Flood Coverage, the Debris Removal Additional Coverage (and any additional limit for Debris Removal under a Limit of Insurance clause or an endorsement) is not applicable and is replaced by the following: Debris Removal 1. We will pay your expense to remove debris of Covered Property and other debris that is on the

described premises, when such debris is caused by or results from Flood. However, we will not pay to remove deposits of mud or earth from the grounds of the described premises.

2. We will also pay the expense to remove debris of Covered Property that has floated or been hurled

off the described premises by Flood. 3. This coverage for Debris Removal, as set forth in D.1. and D.2. above, does not increase the

applicable Limit of Insurance for Flood. Therefore, the most we will pay for the total of debris removal and loss or damage to Covered Property is the Limit of Insurance for Flood that applies to the Covered Property at the affected described premises covered under this endorsement.

E. Limit Of Insurance

1. General Information

Flood Coverage may be written at a Limit of Insurance that is equal to or less than the Limit of Insurance which applies to other Covered Causes of Loss (e.g., Fire) under this Commercial Property Coverage Part. The Limit Of Insurance for Flood is shown in the Flood Coverage Endorsement.

2. Application Of Limit And Aggregate

The Limit of Insurance for Flood is the most we will pay in a single occurrence of Flood for loss or damage caused by the Flood. If there is more than one Flood in a 12-month period (starting with the beginning of the present annual policy period), the most we will pay for the total of all loss or damage sustained during that period of time and caused by Flood is the amount that is identified as the Annual Aggregate for Flood as shown in the Flood Coverage Endorsement. If the Limit of Insurance and the Annual Aggregate amount are the same then the Limit of Insurance is the most we will pay for the total of all loss or damage that is caused by Flood in a 12-month period (starting with the beginning of the present annual policy period), even if there is more than one occurrence of Flood during that period of time. Thus, if the first Flood does not exhaust the applicable Limit of Insurance, then the balance of that Limit is available for a subsequent Flood(s).



If a single occurrence of Flood begins during one annual policy period and ends during the following annual policy period, any Limit of Insurance or Annual Aggregate applicable to the following annual policy period will not apply to that Flood.

3. Ensuing Loss

In the event of covered ensuing loss, for example, loss caused by Fire, Explosion and/or Sprinkler Leakage which results from the Flood, the most we will pay, for the total of all loss or damage caused by flood, fire, explosion and sprinkler leakage, is the Limit of Insurance applicable to Fire. We will not pay the sum of the Fire and Flood Limits.

EXAMPLES – ENSUING LOSS Two examples follow, using these facts: The Commercial Property Coverage Part, in these examples, includes the Causes Of Loss – Basic Form (which covers fire) and this Flood Coverage Endorsement. A building is damaged by Flood and by Fire which is caused by the Flood. The value of the damaged building is $1,000,000. The Limit of Insurance applicable to the building, for the Basic Causes of Loss, is $800,000. The Limit of Insurance for Flood is $400,000. The Flood Deductible amount is $5,000. EXAMPLE 1 The damage due to Flood is $500,000. The damage due to Fire is $500,000. Payment for Flood damage is $400,000 ($500,000 damage minus $5,000 Flood deductible = $495,000; Limit is $400,000). Payment for Fire damage is $400,000 ($500,000 damage capped at the difference between the Basic Limit and the Flood Limit). Total Loss Payment is $800,000. EXAMPLE 2 The damage due to Flood is $800,000. The damage due to Fire is $100,000. Payment for Flood damage is $400,000 ($800,000 damage minus $5,000 Flood deductible = $795,000; Limit is $400,000). Payment for Fire damage is $100,000 (amount of damage). Total Loss Payment is $500,000. Note: These examples are given only to illustrate the situation of Flood and ensuing loss. Therefore, the loss payment stated for Flood damage does not address the situation where another policy also covers the Flood damage. F. Deductible

1. The Deductible for coverage provided under this endorsement is the Deductible applicable to Flood

as shown in the Flood Coverage Endorsement. 2. We will not pay that part of the loss that is attributable to any Deductible(s) in the National Flood

Insurance Program policy. 3. If Flood results in another Covered Cause of Loss and if both Covered Causes of Loss cause loss

or damage, then only the higher deductible applies (e.g., the Flood deductible or the Fire deductible).



G. Other Insurance

The Other Insurance Commercial Property Condition is replaced by the following with respect to the coverage provided under this endorsement: 1. If the loss is also covered under a National Flood Insurance Program (NFIP) policy, or if the

property is eligible to be written under an NFIP policy but there is no such policy in effect, then we will pay only for the amount of loss in excess of the maximum limit that can be insured under that policy. This provision applies whether or not the maximum NFIP limit was obtained or maintained, and whether or not you can collect on the NFIP policy. We will not, under any circumstances, pay more than the applicable Limit Of Insurance for Flood as stated in this Flood Coverage Endorsement.

However, this Provision G.1. does not apply under the following circumstances: a. At the time of loss, the property is eligible to be written under an NFIP policy but such

policy is not in effect due solely to ineligibility of the property at the time this Flood Coverage Endorsement was written.

2. If there is other insurance covering the loss, other than that described in G.1. above, we will pay

our share of the loss. Our share is the proportion that the applicable Limit of Insurance under this endorsement bears to the total of the applicable Limits of Insurance under all other such insurance. But we will not pay more than the applicable Limit Of Insurance stated in this Flood Coverage Endorsement.

All other terms and conditions of this policy remain unchanged.

EXPLANATORY MEMORANDUM

Greenwich Insurance Company and XL Insurance America, Inc. are filing a Flood Coverage Endorsement (GXIP 406 0815) and corresponding rule page (XLP-XL-FLOOD COVERAGE-MU 0815) for our North American Programs division's use. This form and rule page will be used with ISO's Building & Personal Property form CP 00 10 and Special Form Causes of Loss (CP 10 30).

c/w state form

Form number w/ edition date

Form Title Form Description Form TypeMandatory (M) or Optional (O)

Replaces Form

Restrict (R), Broaden (B) or Clarify (C)

Form Usage- Election per

Insured's Request or U/W

Decision

Rate Impact (Y/N)

% Change (CA)

Flat Rate (CA)

CW GXIP 406 0815 FLOOD COVERAGE ENDORSEMENT This endorsement expands policy to include Flood as an additional Covered Cause Of Loss.

End O N/A B Insureds Request

Y see rule pasee rule pa

1

4/19/2011 page 1 of 7

LOUISIANA DEPARTMENT OF INSURANCESTATEMENT OF COMPLIANCE

POLICY FORM / RATE / ADVERTISING FILING

Insurer Name:

Product Code: P0202-000000

NAIC #:

Product Name: Commercial Property

Company Tracking #:

Policy Holder Type:

Filing Submission Date:

The Certification of Compliance Form CANNOT BE FILED for this product type. Form Filing Requirements Form - Section / Page #

LRS-22:§860 A Warranties and misrepresentations by the insured made in the negotiation of acontract cannot be deemed material or void the contract unless such is madewith the intent to deceive.

LRS-22:§864 B(1) A policy shall specify the names of the parties to the contract. The insurer'sname and if not a life insurer, the type of organization shall be clearly shown inthe policy.

LRS-22:§864 B(2) A policy shall specify the subject of the insurance.

LRS-22:§864 B(3) A policy shall specify the risks insured against.

LRS-22:§864 B(4) A policy shall specify the time at which the insurance thereunder takes effect andthe period during which the insurance is to continue.

LRS-22:§864 B(5) A policy shall include a statement of the premium. If other than life, accident orhealth, or title insurance, the premium rate should also be specified.

LRS-22:§864 B(6) A policy shall specify the conditions pertaining to the insurance.

LRS-22:§864 B(8) Every printed portion of the text matter of the policy and of any endorsements orattached papers shall be printed in uniform, no less than ten-point type. The textmatter shall include all printed matter except the name and address of theinsurer, name or title of the policy, captions, sub-captions, and form numbers.

LRS-22:§864 B(9) Each policy form, including riders and endorsements, shall be identified by a formnumber in the lower left-hand corner of each page.

LRS-22:§869 Every insurance contract shall be executed in the name of and on behalf of theinsurer by its officer, employee, or representative duly authorized by the insurer. A facsimile signature of any such executing officer, employee, or representativemay be used in lieu of an original signature.

Greenwich Ins. Co., XL Ins. America, Inc.

22322, 24554

15MX-XP-CP02-MU-LA-F

11/5/15

n/a

acknowledged

satisfied

satisfied, GXIP 406 0815, pages 1 and 3

acknowledged

acknowledged

GXIP 406, page 5

satisfied

satisfied

acknowledged

LA Product Code: P0202-000000 Product Name: Commercial Property

4/19/2011 page 2 of 7

Form Filing Prohibitions Form - Section / Page #

LRS-22:§868 A(2) No insurance contract shall contain any condition, stipulation, or agreementdepriving the courts of this state of the jurisdiction of action against the insurer.

Limitations Form - Section / Page #

LRS-22:§868 B* The prescription period for first-party property claims must be 24 months orlonger under property lines of business.

Exclusions Form - Section / Page #

LRS-22:§1311 H Terrorism exclusions allowed for commerical property and casualty coverages;policy must so state.

Limitations / Exclusions Form - Section / Page #

LDI Advisory 01-01:Advisory 01-01

Use of Pollution Exclusions in Commercial Lines Policy Forms


Use of Mold Exclusions in Insurance Policy Forms


Use of Standard Pollution Exclusions; Commercial lines

LRS-22:§1318 Valued policy clause; exceptions

LRS-22:§1318 A Under any fire insurance policy insuring immovable property in this state, if theinsurer places a valuation upon the covered property and uses such valuation forpurposes of determining the premium for the policy, in the case of total loss theinsurer shall compute and indemnify or compensate any covered loss of, ordamage to, such property which occurs during the term of the policy at suchvaluation without deduction or offset, unless a different method is to be used inthe computation of loss, in which case, the policy, and any application therefore,shall set forth in type of equal size, the actual method of such loss computationby the insurer. Coverage may be voided under said contract in the event ofcriminal fault on the part of the insured or the assigns of the insured.

acknowledged

n/a

n/a

n/a

n/a

n/a

n/a

n/a


4/19/2011 page 3 of 7

Loss Conditions Form - Section / Page #

LRS-22:§1311 F* The Standard Fire Policy specifically states that insurers must, at the time of loss,"repair or replace the property with material of like kind and quality." Provisionsstating that covered losses will be repaired with functional replacement parts,equivalent property, or commonly used material are not acceptable. Suchlanguage would allow loss settlement to fall below the minimum mandated bystatute.

Subrogation / Right of Recovery Form - Section / Page #

LDI Dir 175:Dir 175 Policy Forms - Subrogation Provisions

LRS-22:§882 Under any policy of insurance which authorizes the insured to waive the right ofrecovery 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 invalidatingthe policy the right of recovery against any of the following: (1) Anyone insuredunder the same policy; (2) A corporation, partnership or other entity in which theinsured owns stock or has a proprietary interest; (3) Anyone who owns stock orhas a proprietary interest in the insured; (4) An employee or employer of theinsured; (5) Anyone having an interest as owner, lessor or lessee of the insuredpremises or the premises on which the loss occurred and the employees,partners and stockholders of such owner, lessor or lessee; and (6) Any relativeby blood or marriage of the insured. The insurer shall be entitled to recover fromthe insured any compensation received by the insured for such waiver after lossnot to exceed the amount paid to the insured for such loss by the insurer.

Cancellation / Termination Provisions Form - Section / Page #

LRS-22:§1266 D(3)(a)(i) Payment of an initial, renewal, or installment insurance premium by the insuredto an insurer or an insurance agent with a check or other negotiable instrumentwhich is returned to the payee by the institution upon which it is drawn shall bedeemed grounds for the insurer to cancel the binder or policy from the date thepremium payment was due for the initial or renewal term.

LRS-22:§1267 The cancellation provisions for commercial insurance, including commercialproperty, commercial auto, commercial multi-peril, workers' compensation,professional errors and omissions, and commercial liability policies, must complywith LRS 22:§1267. If your policy form has cancellation provisions, then give theform number and page number in the space provided.

n/a

n/a

n/a

n/a

n/a


4/19/2011 page 4 of 7


LRS-22:§1267 C(1) 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 leastsixtydays before the cancellation effective date, except in cases wherecancellation isbased on nonpayment of premium. Notice of cancellation basedon nonpaymentof premium shall be mailed or delivered at least ten days prior tothe effective dateof cancellation. After coverage has been in effect for more thansixty days or afterthe effective date of a renewal policy, no insurer shall cancel apolicy unless thecancellation is based on at least one of the following reasons:nonpayment ofpremium; fraud or material misrepresentation by the insured; activities oromissions on the part of the insured which change or increase any hazardinsured against; change in the risk which increases the risk of loss after insurancecoverage has been issued or renewed; determination by the commissioner ofinsurance that the continuation of the policy would jeopardize a company'ssolvency or would place the insurer in violation of the insurance laws of this stateor any other state; violation or breach by the insured of any policy terms orconditions; or such other reasons approved by the commissioner of insurance.

LRS-22:§1267 C(2)(a) A notice of cancellation of coverage shall be in writing, mailed or delivered to thefirst-named insured at the mailing address as shown on the policy. Notices ofcancellation for reasons other than nonpayment of premium shall be mailed ordelivered at least thirty days prior to the effective date of the cancellation; noticesof cancellation for nonpayment of premium shall be mailed or delivered at leastten days prior to the effective date of cancellation. The notice shall state theeffective date of the cancellation.

LRS-22:§1267 C(2)(b) The insurer shall provide the first-named insured with a written statement settingforth the reason for the cancellation where the insured requests such a statementin writing and the named insured agrees in writing to hold the insurer harmlessfrom liability for any communication giving notice of or specifying the reasons fora cancellation or for any statement made in connection with an attempt todiscover or verify the existence of conditions which would be a reason forcancellation.

LRS-22:§1268 A Any refund due an insured because of either cancellation, elimination, orreduction of coverage by the insurer or the insured, shall be accompanied withinterest at the rate of one and one-half percent per month of the amount of therefund due the customer, without the benefit of daily proration of this monthlyinterest, after thirty days of either of the following: the delivery to the insured ofthe written notice of such cancellation, elimination, or reduction; or delivery to theinsurer's state, regional, or home office, from which such refund would issue, ofthe written request for such cancellation, elimination, or reduction.

LRS-22:§885 Cancellation by the insured; surrender: Within 30 days following cancellation bythe insured, the insurer shall pay the insured any unearned portion of anypremium computed on a pro rata basis. An assessment of a monetary penalty byan insurer against an insured as a result of the insured’s cancellation prior to theexpiration of any policy is prohibited.

n/a

n/a

n/a

n/a

n/a


4/19/2011 page 5 of 7


LRS-22:§887 A(2) Like notice must also be so delivered or mailed to each mortgagee, pledgee, orother known person shown by the policy to have an interest in any loss whichmayoccur thereunder.

LRS-22:§887 D The portion of any premium paid to the insurer on account of the policy, includingunearned commission, must be actually paid to the insured or other personentitled thereto as soon as practicable following such cancellation.

Nonrenewal Provisions Form - Section / Page #

LRS-22:§1267 D(1) An insurer may decide not to renew a policy if it delivers or mails written notice itwill not renew the policy. Such notice of nonrenewal shall be mailed or deliveredat least sixty days before the expiration date. Such notice to the insured shallinclude the insured's loss run information for the period the policy has been inforce within, but not to exceed, the last three years of coverage. If the notice ismailed less than sixty days before expiration, coverage shall remain in effectunder the same terms and conditions until sixty days after notice is mailed ordelivered. Earned premium for any period of coverage that extends beyond theexpiration date shall be considered pro rata based upon the previous year's rate.

LRS-22:§1267 D(2) Notice of nonrenewal shall not be required if the insurer or a company within thesame insurance group has offered to issue a renewal policy, or where the namedinsured has obtained replacement coverage or has agreed in writing to obtainreplacement coverage.

Premium Rating Requirements Form - Section / Page #

LDI Bltn 09-03:Bltn 09-03 Schedule Rating Plans for Commercial Property and Casualty Insurers

LDI Bltn 09-09:Bltn 09-09 Submittal of Consent-to-Rate Filings, A-Rated Filings and Individual Risk RelatedFilings

LRS-22:§1464 Rate Filing

Premium Rate Adjustment Form - Section / Page #

LRS-22:§1267 E(1) An insurer shall mail or deliver to the named insured at the mailing addressshown on the policy written notice of any rate increase, change in deductible, orreduction in limits or coverage at least thirty days prior to the expiration date ofthe policy. If the insurer fails to provide such thirty-day notice, the coverageprovided to the named insured at the expiring policy's rate, terms, and conditionsshall remain in effect until notice is given or until the effective date of replacementcoverage obtained by the named insured, whichever first occurs.

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a


4/19/2011 page 6 of 7

Premium Rate Adjustment Form - Section / Page #

LRS-22:§1267 E(2) This Subsection shall not apply to the following: changes in a rate or plan filedwiththe insurance rating commission and applicable to an entire class of business;changes based upon the altered nature or extent of the risk insured; changes inpolicy forms filed and approved with the commissioner and applicable to an entireclass of business; or changes requested by the insured.

LRS-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.

LRS-22:§1484 A (2) Notice requirements for additional premium for commercial and noncommercialproperty, casualty or liability insurance policy where there has been a materialchange.

LRS-22:§1484 C Rate changes at renewal

General / Standard Provisions Form - Section / Page #

LRS-22:§1311 Fire insurance contract; standard provisions; variations.

LRS-22:§1314 No policy of fire insurance shall be declared void by the insurer for the breach ofany representation, warranty or condition contained in the said policy or in theapplication therefor. Such breach shall not avail the insurer to avoid liabilityunless such breach (1) shall exist at the time of the loss, and be either such abreach as would increase either the moral or physical hazard under the policy, or(2) shall be such a breach as would be a violation of a warranty or conditionrequiring the insurer to take and keep inventories and books showing a record ofhis business.

Claim Filing Provisions Form - Section / Page #

LRS-22:§ 1264 Extension of proof of loss requirements in regards to a catastrophic event.

LRS-22:§1312 Upon receiving notice of loss from the insured, the insurer shall furnish withinthirty days to the insured a form suitable for filing a proof of loss and shall advisethe insured that he is required under the terms of the policy to submit a proof ofloss.

LRS-22:§1892 A(1) Payment required within 30 days after satisfactory proof of loss.

LRS-22:§1892 A(2) Third party claims must be paid within 30 days, after written agreement ofsettlement.

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a


4/19/2011 page 7 of 7

Claim Filing Provisions Form - Section / Page #

LRS-22:§1892 A(4) All insurers shall make written offer to settle property damage claims within 30days of receipt of proofs of loss.

Application / Enrollment Form Form - Section / Page #

LRS-40:§1424(B) Required Fraud Statement. "Any person who knowingly presents a false orfraudulent claim for payment of a loss or benefit or knowingly presents falseinformation in an application for insurance is guilty of a crime and may be subjectto fines and confinement in prison."

Disclosure / Notice Requirements Form - Section / Page #

LRS-22:§ 1319 Promulgated Disclosure Notice Required. All fire insurance contracts providingcoverage for damage to property delivered in this state must provide a disclosureof coverage; disclosure of coverage for damages due to flood and mold; anddisclosure of separate hurricane, wind or named-storm deductibles, including astandardized example of how deductible will be applied.

LRS-22:§1331 Personal property coverage; option to exclude

n/a

n/a

n/a

n/a



Insurer Name: Product Code: P0202-000000

NAIC #: Product Name: Commercial Property

Company Tracking #: Policy Holder Type:


The Certification of Compliance Form CANNOT BE FILED for this product type.

Form Filing Requirements Description Form - Section / Page #

La. R.S. 22:§860 AWarranties and misrepresentations by the insured made in the negotiation of acontract cannot be deemed material or void the contract unless such is made withthe 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 nameand if not a life insurer, the type of organization shall be clearly shown in thepolicy.

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 andthe period during which the insurance is to continue.

La. R.S. 22:§864 B(5) A policy shall include a statement of the premium. If other than life, accident orhealth, or title insurance, the premium rate should also be specified.

11/16/2015 page 1 of 8


22322, 24554


11/5/15

n/a

acknowledged

satisfied


acknowledged

acknowledged

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 orattached papers shall be printed in uniform, no less than ten-point type. The textmatter 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 formnumber 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 theinsurer by its officer, employee, or representative duly authorized by the insurer.A facsimile signature of any such executing officer, employee, or representativemay be used in lieu of an original signature.

Form Filing Prohibitions Description Form - Section / Page #

La. R.S. 22:§868 A(2) No insurance contract shall contain any condition, stipulation, or agreementdepriving the courts of this state of the jurisdiction of action against the insurer.

Limitations Description Form - Section / Page #

La. R.S. 22:§868 B* The prescription period for first-party property claims must be 24 months or longerunder property lines of business.

Exclusions Description Form - Section / Page #

La. R.S. 22:§1311 H Terrorism exclusions allowed for commercial property and casualty coverages;policy must so state.

Limitations / Exclusions Description Form - Section / Page #

La. R.S. 22:§1318 Valued policy clause; exceptions


11/16/2015 page 2 of 8

GXIP 406, page 5

satisfied

satisfied

acknowledged

acknowledged

n/a

n/a

n/a

La. R.S. 22:§1318 A

Under any fire insurance policy insuring immovable property in this state, if theinsurer places a valuation upon the covered property and uses such valuation forpurposes of determining the premium for the policy, in the case of total loss theinsurer shall compute and indemnify or compensate any covered loss of, ordamage to, such property which occurs during the term of the policy at suchvaluation without deduction or offset, unless a different method is to be used in thecomputation of loss, in which case, the policy, and any application therefore, shallset forth in type of equal size, the actual method of such loss computation by theinsurer. Coverage may be voided under said contract in the event of criminal faulton the part of the insured or the assigns of the insured.

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

LDI Advisory 97-01:Advisory 97-01 Use of Standard Pollution Exclusions; Commercial lines

Loss Conditions Description Form - Section / Page #

La. R.S. 22:§1311 F*

The Standard Fire Policy specifically states that insurers must, at the time of loss,"repair or replace the property with material of like kind and quality." Provisionsstating that covered losses will be repaired with functional replacement parts,equivalent property, or commonly used material are not acceptable. Suchlanguage would allow loss settlement to fall below the minimum mandated bystatute.


11/16/2015 page 3 of 8

n/a

n/a

n/a

n/a

n/a

Subrogation / Right of Recovery Description Form - Section / Page #

La. R.S. 22:§882

Under any policy of insurance which authorizes the insured to waive the right ofrecovery 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 invalidatingthe policy the right of recovery against any of the following: (1) Anyone insuredunder the same policy; (2) A corporation, partnership or other entity in which theinsured owns stock or has a proprietary interest; (3) Anyone who owns stock orhas a proprietary interest in the insured; (4) An employee or employer of theinsured; (5) Anyone having an interest as owner, lessor or lessee of the insuredpremises or the premises on which the loss occurred and the employees, partnersand stockholders of such owner, lessor or lessee; and (6) Any relative by blood ormarriage of the insured. The insurer shall be entitled to recover from the insuredany compensation received by the insured for such waiver after loss not to exceedthe amount paid to the insured for such loss by the insurer.

LDI Dir 175:Dir 175

Subrogation Provisions – The Commissioner will consider for approval languagethat clearly conveys to the insured that any right of recovery from third parties inthe part of the insurer, whether by subrogation or reimbursement, is subordinateto the insured’s right to be fully compensated for his damages; and that the insureris obligated to share in legal expenses incurred. The Commissioner will notapprove policy language that excludes and/or reduces coverage for expensesincurred as a result of treatment of injury or sickness caused by the fault of a thirdparty.

Cancellation / TerminationProvisions Description Form - Section / Page #

La. R.S. 22:§1266 D(3)(a)(i)

Payment of an initial, renewal, or installment insurance premium by the insured toan insurer or an insurance agent with a check or other negotiable instrumentwhich is returned to the payee by the institution upon which it is drawn shall bedeemed grounds for the insurer to cancel the binder or policy from the date thepremium payment was due for the initial or renewal term.

La. R.S. 22:§1267

The cancellation provisions for commercial insurance, including commercialproperty, commercial auto, commercial multi-peril, workers' compensation,professional errors and omissions, and commercial liability policies, must complywith LRS 22:§1267. If your policy form has cancellation provisions, then give theform number and page number in the space provided.


11/16/2015 page 4 of 8

n/a

n/a

n/a

n/a

La. R.S. 22:§1267 C(1)

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 sixtydays before the cancellation effective date, except in cases where cancellation isbased on nonpayment of premium. Notice of cancellation based on nonpaymentof premium shall be mailed or delivered at least ten days prior to the effective dateof cancellation. After coverage has been in effect for more than sixty days or afterthe effective date of a renewal policy, no insurer shall cancel a policy unless thecancellation is based on at least one of the following reasons: nonpayment ofpremium; fraud or material misrepresentation by the insured; activities oromissions on the part of the insured which change or increase any hazard insuredagainst; change in the risk which increases the risk of loss after insurancecoverage has been issued or renewed; determination by the commissioner ofinsurance that the continuation of the policy would jeopardize a company'ssolvency or would place the insurer in violation of the insurance laws of this stateor any other state; violation or breach by the insured of any policy terms orconditions; or such other reasons approved by the commissioner of insurance.

La. R.S. 22:§1267 C(2)(a)

A notice of cancellation of coverage shall be in writing, mailed or delivered to thefirst-named insured at the mailing address as shown on the policy. Notices ofcancellation for reasons other than nonpayment of premium shall be mailed ordelivered at least thirty days prior to the effective date of the cancellation; noticesof cancellation for nonpayment of premium shall be mailed or delivered at leastten days prior to the effective date of cancellation. The notice shall state theeffective date of the cancellation.

La. R.S. 22:§1267 C(2)(b)

The insurer shall provide the first-named insured with a written statement settingforth the reason for the cancellation where the insured requests such a statementin writing and the named insured agrees in writing to hold the insurer harmlessfrom liability for any communication giving notice of or specifying the reasons for acancellation or for any statement made in connection with an attempt to discoveror verify the existence of conditions which would be a reason for cancellation.

La. R.S. 22:§1268 A

Any refund due an insured because of either cancellation, elimination, or reductionof coverage by the insurer or the insured, shall be accompanied with interest atthe rate of one and one-half percent per month of the amount of the refund duethe customer, without the benefit of daily proration of this monthly interest, afterthirty days of either of the following: the delivery to the insured of the written noticeof such cancellation, elimination, or reduction; or delivery to the insurer's state,regional, or home office, from which such refund would issue, of the writtenrequest for such cancellation, elimination, or reduction.

La. R.S. 22:§885

Cancellation by the insured; surrender: Within 30 days following cancellation bythe insured, the insurer shall pay the insured any unearned portion of anypremium computed on a pro rata basis. An assessment of a monetary penalty byan insurer against an insured as a result of the insured’s cancellation prior to theexpiration of any policy is prohibited.

La. R.S. 22:§887 A(2)Like notice must also be so delivered or mailed to each mortgagee, pledgee, orother known person shown by the policy to have an interest in any loss which mayoccur thereunder.


11/16/2015 page 5 of 8

n/a

n/a

n/a

n/a

n/a

n/a

La. R.S. 22:§887 DThe portion of any premium paid to the insurer on account of the policy, includingunearned commission, must be actually paid to the insured or other personentitled thereto as soon as practicable following such cancellation.

Nonrenewal Provisions Description Form - Section / Page #

La. R.S. 22:§1267 D(1)

An insurer may decide not to renew a policy if it delivers or mails written notice itwill not renew the policy. Such notice of nonrenewal shall be mailed or deliveredat least sixty days before the expiration date. Such notice to the insured shallinclude the insured's loss run information for the period the policy has been inforce within, but not to exceed, the last three years of coverage. If the notice ismailed less than sixty days before expiration, coverage shall remain in effectunder the same terms and conditions until sixty days after notice is mailed ordelivered. Earned premium for any period of coverage that extends beyond theexpiration date shall be considered pro rata based upon the previous year's rate.

La. R.S. 22:§1267 D(2)

Notice of nonrenewal shall not be required if the insurer or a company within thesame insurance group has offered to issue a renewal policy, or where the namedinsured has obtained replacement coverage or has agreed in writing to obtainreplacement coverage.

Premium Rating Requirements Description Form - Section / Page #

La. R.S. 22:§1464 Rate Filing



Premium Rate Adjustment Description Form - Section / Page #

La. R.S. 22:§1267 E(1)

An insurer shall mail or deliver to the named insured at the mailing address shownon the policy written notice of any rate increase, change in deductible, or reductionin limits or coverage at least thirty days prior to the expiration date of the policy. Ifthe insurer fails to provide such thirty-day notice, the coverage provided to thenamed insured at the expiring policy's rate, terms, and conditions shall remain ineffect until notice is given or until the effective date of replacement coverageobtained by the named insured, whichever first occurs.


11/16/2015 page 6 of 8

n/a

n/a

n/a

n/a

n/a

n/a

n/a

La. R.S. 22:§1267 E(2)

This Subsection shall not apply to the following: changes in a rate or plan filedwith the insurance rating commission and applicable to an entire class ofbusiness; changes based upon the altered nature or extent of the risk insured;changes in policy forms filed and approved with the commissioner and applicableto an entire class of business; or changes requested by the insured.

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 noncommercialproperty, casualty or liability insurance policy where there has been a materialchange.

La. R.S. 22:§1484 C Rate changes at renewal

General / Standard Provisions Description Form - Section / Page #

La. R.S. 22:§1311 Fire insurance contract; standard provisions; variations.

La. R.S. 22:§1314

No policy of fire insurance shall be declared void by the insurer for the breach ofany representation, warranty or condition contained in the said policy or in theapplication therefor. Such breach shall not avail the insurer to avoid liabilityunless such breach (1) shall exist at the time of the loss, and be either such abreach as would increase either the moral or physical hazard under the policy, or(2) shall be such a breach as would be a violation of a warranty or conditionrequiring the insurer to take and keep inventories and books showing a record ofhis business.

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:§1312

Upon receiving notice of loss from the insured, the insurer shall furnish withinthirty days to the insured a form suitable for filing a proof of loss and shall advisethe insured that he is required under the terms of the policy to submit a proof ofloss.


11/16/2015 page 7 of 8

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

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 ofsettlement.

La. R.S. 22:§1892 A(4) All insurers shall make written offer to settle property damage claims within 30days of receipt of proofs of loss.

Application / Enrollment Form Description Form - Section / Page #

La. R.S. 40:§1424(B)

Required Fraud Statement. "Any person who knowingly presents a false orfraudulent claim for payment of a loss or benefit or knowingly presents falseinformation in an application for insurance is guilty of a crime and may be subjectto fines and confinement in prison."

Disclosure / NoticeRequirements Description Form - Section / Page #

La. R.S. 22:§ 1319

Promulgated Disclosure Notice Required. All fire insurance contracts providingcoverage for damage to property delivered in this state must provide a disclosureof coverage; disclosure of coverage for damages due to flood and mold; anddisclosure of separate hurricane, wind or named-storm deductibles, including astandardized example of how deductible will be applied.


11/16/2015 page 8 of 8

n/a

n/a

n/a

n/a

n/a