daho Surveying & Rating Bureau, Inc. 1871 South Cobalt Point Way Tel: (208) 343-5483 Meridian, Idaho 83642 FAX: (208) 895-8059 www.isrb.com Alfred C. Frieze, CPCU e-mail firstname.lastname@example.org Secretary - General Manager April 2, 2012 TO THE MANAGEMENT: RE: CALL FOR 2011 IDAHO PREMIUMS Enclosed is the material need to report your company's premiums as required by your affiliation agreement with the Idaho Surveying & Rating Bureau, Inc. The affiliation agreement also covers your obligation to affiliate each company in your group with the Bureau, if they are writing property insurance in Idaho. This includes companies that are writing under the provisions of the Surplus Lines Law, as well as companies with a Certificate of Authority. The Report of Premium form provided space for either the name of the individual company that is affiliated with the Bureau, or a group name with separate area to list each company in the group in the lower section of the report. If a company has left your group please provide a contact for that company so we can process that company's report. If a company has joined your group, please check http://www.isrb.com/pubs/Affiliation%20Report.pdf to see if that company is affiliated if so please include that company's Idaho premiums. If the company is not affiliated please execute the enclosed Application and appropriate agreement. Make as many copies of these forms as you need. See http://www.isrb.com/affiliation.htm for details or contact me. Please remember to omit 000, when filing the premium report for 2011. We would also like to remind you to be specific on line 3C1b under commercial multi-peril, and line 3C2c under indivisible package. We wish to call attention to the “Instructions”, since we believe correspondence may be eliminated if the needs of the Bureau in these respects are fully understood. One important item is that all companies affiliated with the Bureau that are in a group may provide one report covering the requested premiums written in Idaho. The basic assessment is based on each premium report submitted. It would be appreciated if you would complete the form, retain a copy for your file, and return the other to the Bureau no later than July 2, 20112. Please note the ISO Premium Reporting Form also lists the State of Idaho, however, the enclosed form will need to be completed and submitted to this Bureau since we assess independently on property insurance written in Idaho for Bureau operation. To facilitate the data verification the Board of Directors has authorized the collection of Fire and Casualty Annual Statements to be submitted electronically. These are the same filing you make to the NAIC. Files should be your company's zipped file that contains the s.txt file format. Please e-mail to email@example.com Sincerely, Alfred C. Frieze Alfred C. Frieze, CPCU Secretary - General Manager ACF:eg C:\Docstoc\Working\pdf\9ace4c36-0d41-461c-99fe-a875354197ce.doc Idaho Surveying and Rating Bureau, Inc. REPORT OF PREMIUMS WRITTEN DURING 2011 1871 S Cobalt Point Way Meridian ID 83642 firstname.lastname@example.org *Company or Group Name Group NAIC # Company NAIC # In the State of Idaho DIRECT PREMIUMS WRITTEN -A- -B- Report Premiums to the nearest thousand dollars. (000) omitted. Independent Bureau Line See instructions for details Program(s) Program(s) (000) omitted (000) omitted 1 DWELLING PROPERTY A. Dwelling Monoline (Fire, EC & Allied Lines) B. Homeowner Multi-Peril Policies. 2. FARM PROPERTY A. Farm Monoline (Fire, EC & Allied Lines) B. Farm-Ranchowners 3. COMMERCIAL PROPERTY A. Commercial Monoline B. Countrywide Rated & Highly Protected Risks C. Commercial Multi-Peril 1. Divisible Package Policy Premiums a) Fire, EC, Allied Lines & Earthquake b) Any other (specify) 2. Indivisible Package Policy Premiums. NOTE: Only use this section for premiums not included in C.1. above a) Businessowners b) Manufacturers Output (MOP) c) Any other (specify) Column A Column B Col A + B Sub-Total Sub-Total Sub-Total 4. TOTAL PREMIUMS REPORTED ABOVE 5. Premiums not List: reported above See Instructions TOTAL 6. ANNUAL STATEMENT - DIRECT PREMIUMS WRITTEN - Page 20-ID, Column 1 Line 1 Fire Line 2.1 Allied Lines Line3 Farmowners Line 4 Homeowners Line 5.1CMP Line 12 Earthquake Total *If this report covers a group, please list all of the companies included in this report. Only the companies in a group writing property insurance in Idaho are required . Include all premiums from both admitted and non-admitted companies. Use additional sheet if necessary. We certify that the premiums herein are, to the best of our knowledge correct and in accordance with the instructions covering this form. Printed Name Title Phone Signature Date E-mail From isrb.com INSTRUCTIONS FOR COMPLETING PREMIUM REPORT FORM This report can be e-mailed to email@example.com GENERAL These instructions are for your guidance in properly completing the premium report for the Idaho Surveying and Rating Bureau, Inc. in accordance with Article X Section 2 of the Bylaws. COMPANY NAME This report is for the company named as it appears on the bureau record. If the name has changed, please correct it. If the name of the group has changed, or if the individual company is now part of a group, or has separated from the group, please so indicate. GROUP REPORTING Companies under common management may submit a combined premium report. If this report covers a group, please list all of the companies included in this report. Only the companies in a group writing property insurance in Idaho are required. Include all premiums from both admitted and non-admitted companies DIRECT PREMIUMS WRITTEN (COLUMNS A & B) Report all gross premiums written (not reinsurance premiums received) less cancellation and return premiums. Do not deduct dividends or participation to policyholders from the premiums reported. Include the company’s share of premiums from associations, pool arrangements, or jointly operated underwriting agencies. Exclude premiums obtained from Railroad Property, the Cotton Insurance Association, and the Fire and Marine Underwriters. Premiums that do not use loss costs, rules (including PPC and BCEGS Classifications) or forms are to be reported on line 6 and described as "No ISRB material used." REPORT PREMIUMS TO THE NEAREST THOUSAND DOLLARS Premiums are to be reported with the last, 000 omitted. Premiums of $500.00 or less are to be entered as 0. All other premiums are to be rounded to the nearest thousand dollars (i.e. 50,389 = 50, and 50,541 = 51). INDEPENDENT PROGRAMS (COLUMN -A-) Report all premiums from programs that are not based on bureau loss costs, rules, or forms. This includes premiums that use only public protection and/or building code effectiveness classifications in any form not just in pricing but in underwriting or determining suitability for programs and underwriting qualifications. Rules are defined to include use of public protection and building code effectiveness classifications. BUREAU PROGRAMS (COLUMN -B-) Report all premiums from programs that use bureau loss costs, rules, or forms in any form not just in pricing but in underwriting or determining suitability for programs and underwriting qualifications. Rules are defined to include use of public protection and building code effectiveness classifications. REPORTING BY TYPE OF POLICY OR BY PERIL LINE 1. DWELLING PROPERTY A. Dwelling monoline. Report total premiums from fire, extended coverages, earthquake, and other allied lines. B. Homeowners multi-peril. Report total homeowners premiums. LINE 2. FARM PROPERTY A. Farm monoline. Report total premiums from fire, extended coverages, earthquake, and other allied lines. B. Farmowners-ranchowners. Report total multi-peril farm premiums. LINE 3. COMMERCIAL PROPERTY A. Commercial monoline. Report total premiums from fire, extended coverages, Earthquake, and other allied lines. B. Countrywide Rated & Highly Protected Risks. Report premiums From Countrywide Rating Plans like Electrical Generating Stations, Petroleum Refiners, and Premiums Generated from the Highly Protected Risk Plan. C. 1. Divisible package premiums. Lines C.1. A. And B. Report the premiums for each of the lines requested. If your company plan is not divisible, then put the total premiums under line C.2 c).. C. 2. Indivisible package premiums. Use line C.2 to report total multi-peril package premiums where the premium is not divisible and not included in C.1 LINE 5. Total premiums reported. Subtotal columns “A” and “B”, then put the sum of “A” and “B” in the column marked “A+B”. LINE 6. Premiums not reported above. Report all premiums which have been excluded from lines 1 through 5 above, but which appear in the annual statement on page 20-ID, column 1, lines 1-5.1 and 12. List these individually in the space provided. Add the total of line 5 to these premiums and place the total in the box marked “Total” Annual Statement. Report the Annual Statement premiums (page 20-ID, column 1, line 1-5.1 and line 12) in the space provided. The sum of this line should equal the sum line 6.
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