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					AFFIDAVIT/ANNUAL STATEMENT REPORTING
          FORM INSTRUCTIONS

                                          AFFIDAVIT

All agents who held a Kansas Excess Lines License at anytime during the preceding calendar year must complete
this form.

       a. Complete top area completely (name, resident address, Email addre ss etc.) If business
          was placed through a registered Risk Purchasing Group, list name of the group, complete
          an Affidavit for each Group represented.

       b. If reporting agent placed coverage through another Kansas licensed excess lines agent during
          the previous calendar year, check “Yes” box.

            Form ELAS/AA is NO LONGER required to be filed, however, you are still required
            to maintain a record of all Excess Lines transactions.

            If no other Kansas licensed excess lines agent was involved in the placement of excess
            lines business during the previous calendar year, check “No” box.

Check both boxes if you directly placed business and placed business through another Kansas licensed
excess lines agent.

       c. If you directly placed coverage through a listed Excess Lines carrier during the previous
          calendar year, check “YES” box.

                1. Enter the Gross Premiums charged and the 6% premium tax being paid on the
                   appropriate lines.

       d. If no business was directly placed, check “NO” box. Do not forward ELAS form if no
          business was written.

       e. Reporting agent sign, and complete the requested contact information. Affidavit must have
          ORIGINAL signature of licensed agent.

       f.   Attach a check in the amount-listed payable to the Kansas Insurance Department and
            mail form(s). Submit ELAS, email to: exlines @k s ins urance.org


       IMPORTANT: Reports are DUE & must be
        RECEIVED ON OR BEFORE MARCH 1!
                           ANNUAL STATEMENT REPORTING FORMS

Enter all information requested for excess lines business, which you have transacted and are paying the
premium tax.

        NOTE: Please consolidate all transactions involved on any one policy as a one -line
        entry. Do not split or separate policy transactions onto more than one annual statement
        reporting form. For example if a policy first placed into effect is later modified (additional
        coverage was added or deleted, effective/expiration date revisions, cancellations, etc.),
        please compile or consolidate all transactions for the single policy onto one line of the
        reporting form. *Be sure to enter the total gross premium charged and premium tax due
        in correct column. If a credit is due, enter the total credit amounts in Column L, Premium
        Canceled and Column M, Tax Canceled Columns. (When a credit is taken, do not enter
        the final amount of premium and tax due in the gross premium and premium tax due
        column, you should complete four columns. We require all entries in total amounts.)
        After you enter all columns you may then deduct the total premium tax credit from the
        premium tax due. If you have any questions concerning this, please feel free to contact
        this office.

            INSTRUCTIONS FOR COMPLETING THE ANNUAL STATEMENT
                             REPORTING FORMS

                                        ELAS FORM, Electronic Version
                                             Worksheet Page 1.

This year, ELAS Forms will only be accepted electronically using the attached MS Excel
template. Submissions not filing electronically will be considered incomplete and NO
exceptions will be made.

        MS Excel spreadsheets have been previously transmitted to agents, if agent has not received this form,
        please contact this department.

        COLUMN A, REPORTING AGENT LICENSE NUMBER: Fill in agent’s 9-digit license number, (Social
        Security #).

        COLUMN B, TRANSACTION CODE: Refer to the code on accompanying Coverage Type Form. Indicate
        the type of transaction that is being reported, using the following code: A- audit, C- cancellation,
        E - endorsement, N - new, R - renewal. If codes A, C, or E are used and had been reported on a previous
        report, indicate the page or row number on which the listing can be found.

        COLUMNS C&D, INCEPTION/EXPIRATION DATES : All policies written from January 1 through
        December 31 have to be reported, that includes policies written, but not yet booked.

        COLUMN E, POLICY NUMBER: Numeric and Alpha characters only, no spaces or dashes.

        COLUMN F, NAME OF THE INSURED: Enter the named insured information from the policy’s
        declarations. Please enter insured’s name ONLY.
                                           :
         COLUMN G, COVERAGE TYPE Refer to the code on accompanying Coverage Type Form. Enter only the
          3 digit number instead of typing out the coverage type, i.e., for General Liability- type “270”, for Errors and
          Omissions, type “280”, etc.

          COLUMN H, NON-ADMITTED COMPANY CODE: Refer to attached updated listing of Kansas Non-
          Admitted Insurers to obtain the NAIC Company Number. If various companies were used on any one risk,
          list each company used and applicible premium attributable to each company, multiple rows can be used.
          If Lloyds of London was used, all participating syndicates must be reported in Column N, Notes.

          COLUMN I, PREMIUM: The gross premium is the total amount charged the insured before figuring the 6%
          premium tax. Gross premium would include any cost charged in the placement of the insurance including,
          policy or inspection fees.

          COLUMN J, PREMIUM TAX: Premium tax due is 6% of the amount entered in column I. Note: If the gross
          premium is collected during the reporting year, then the premium          tax should be reported and paid,
          even if the policy has not been received, (written but not yet “booked”).

          COLUMN K, PENALTY TAX: For Department Use

          COLUMN L & M, PREMIUM & PREMIUM TAX CANCELED: The total amount of premium and tax
          canceled should be entered. Refer to page 1 concerning consolidation of all transactions.

          COLUMN N, NOTES: Use this column to list Lloyd’s Syndicates used, list previously reported policy page
          or row, or any other information that you would deem necessary.


Upon completion, scroll down to tab labeled “Agent Name”, right click on Agent Name and type in
reporting agent’s name, last name first, then first name. Save a copy for your files and send a copy to the
Department to: exlines @k s ins urance.org


                                           ELAS FORM, Electronic Version
                                              Worksheet Page 2 and 3

These worksheets are to be used to maintain a record of business that was placed by a Kansas licensed
Excess Lines agent through another Kansas licensed Excess Lines agent that will be reporting and paying
tax owed. Complete and retain a sheet per each agent used. Please do not send these worksheets to the
Department.

Please note we will be changing the format for form ELAS beginning tax
year 2005. Revised copies will be sent out January 2005 to be used in
reporting business written in 2005.

IMPORTANT: Reports are DUE & must be
 RECEIVED ON OR BEFORE MARCH 1!
Instructions
2004
                               K ANSAS INSURANCE DEPARTMENT
                                                     420 S.W. 9th TOPEKA, KANSAS 66612- 1678
                                                                    AFFIDAVIT
                                                    REPORTING 2004 EXCESS LINES PLACEMANTS
         Th is s tatemen t is to b e filed with th e In s u ran ce Dep artmen t b efo re March 1 , 2 0 0 5 . Fo r b u s in es s written d u rin g calen d ar y ear 2 0 0 4 .
                    ALL KANS AS EXCES S LINES LICENS ED AGENTS ARE REQUIRED TO S UBMIT COMPLETED AFFIDAVIT


_____________________________________________________                                               _____ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _           _______________________
NAM E OF LICENSED EXCESS LINES AGENT                                                                   KANSAS LICENSE NUM BER                                           DAT E COM PLET ED


___________________________________________________________________                                                                   _____________________________________
                          NAM E OF INSURANCE AGENCY                                                                                     T ELEPHONE NUM BER


____________________________________________________________________                                                                   _____________________________________
AGENT ‘S BUSINESS ADDRESS                                                                                                                 FAX NUM BER



_______________________________________ ________                                           _____________                   ___________________________________________
              CIT Y                                                       ST AT E              Z IP CODE                        LICENSED AGENT’S EM AIL ADDRESS



_____________________________________________________                                                _______________________________                                  _____________________
         NAM E OF PERSON COM PLET ING REPORT                                                          CONT ACT PERSON EMAIL ADDRESS                                       T ELEPHONE NUM BER



NAM E OF RISK PURCHASING/RET ENT ION GROUP REPRESENT ED: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

I hereby certify that after diligent effort I have been unable to secure the amount of insurance required to protect the properties,
persons, or firms described in this annual report from loss or damage in regularly admitted companies (including the Kans as
Auto mo bile Ins urance Plan, the Wo rk e rs ' Co mpe ns atio n and Emplo ye rs ' Liability As s ig ne d Ris k Plan, the He alth
Care Pro v ide r Ins urance Av ailability Plan, o r the Kans as FAIR Plan, as the case may be) during the year of 2004.

I further certify that under the penalty of perjury under the laws of the state of Kansas, the Annual Statement Reporting Form(s)
attached hereto is/are a full, true and correct list of transactions covering excess lines policies written, renewed or audited by me or
through another duly licensed Kansas Excess Lines Agent(s) during calendar year of 2004.

In c omplianc e w ith the requirements of K. S. A. 40-246b, I hereby make this report of the bus ines s produc ed by me under s aid s tatute:

Excess Lines business placed through other Kansas                                            YES                                                        NO
licensed Agent(s) during 2004:
If yes, complete and RETAIN Form ELAS/AA.

Excess Lines business directly placed during 2004:                                           YES                                                        NO
If yes, complete submit Form ELAS spreadsheet to: exlines@ksinsurance.org

1.      Gross premiums charged:                                                              $ ____________________

2.      Total 6% excess lines premium tax due:                                               $ ____________________
        Attach check for amount of tax listed.

                                                                                                                              __________________________________________
                                                                                                                                                     Signat ure of Excess Lines Agent

Rev ised 0 4 - 0 4                        DAT E RCVD_ _ _ _ _ _ _ _ _ _ _ _ _ _ AMT :$ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CK# _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ FM# _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CODE # 1 3 3 5 - 1 0 0 0
Fo r m Af f idav it 0 4                                                         AMT :$ _ _ _ _ _ _ _ _ _ _ _ _ _ _                                                                     CODE # _ _ _ _ _ _ _ _
                                                                     Coverage Type

010 - Dw elling f ir e, v ac ant dw ellings ( Fir e & Ex tended Cov er age)       020 - Commer c ial f ir e and ex tended c ov er age ( Inc lude EC if indic ated)

030 - Ex tended c ov er age ( us e only if f ir e is not inc luded)               040 - Other A llied Lines , DIC ( Dif f er enc e in c ondition) Bus ines s
                                                                                        inter r uption, ex tr a ex pens e, los s of inc ome

050 - Homeow ner s                                                                060 - Commer c ial Multi- per il, ( pac kage) Spec ial Multi- per il ( SMP) Railr oads

070 - Ex c es s pr oper ty c ov er age, f lood, ex c es s mar ine                 080 - Ear thquake

090 - Oc ean Mar ine, ( oc ean boats )                                            100 - Inland Mar ine, builder s r is k, pr oper ty f loater s , jew elr y , f ine ar ts , oil r igs ,
                                                                                  f ur s , guns , boat

110 -                                                                             120 -

130 - Boiler & Mac hiner y                                                        140 - Primary Priv ate Pas s enger A uto (any auto c ov erage (i.e., liability ,
                                                                                  c ollis ion, c ompr ehens iv e, phy s ic al damage)

145 - Ex c es s Pr iv ate Pas s enger A uto                                       150 - Primary Commerc ial auto (truc kers , phy s ic al damage, liability , c ar
                                                                                  dealer s )

155 - Ex c es s Commer c ial A uto                                                160 - A ir c r af t ( any air c r af t c ov er age ( i.e., liability , phy s ic al damage) )

170 - Cargo Liability (c argo)                                                    180 - Workers Compens ation

190 - Title                                                                       200 - Cr edit ( Cr edit lif e)

210 - Fidelity ( f or ger y , f idelity bonds )                                   220 - Sur ety ( bid, c ompletion bonds )

230 - Bur glar y , Thef t & Robber y , Kidnap Rans om                             240 - Glas s

250 - Pr oduc t Liability ( us e only if pr oduc ts is the only c ov er ages )    260 - Medic al Malprac tic e (doc tors , nurs es , ambulanc e tec hnic ians )

261 - Pr of es s ional Liability ( attor ney s , ac c ountants , c ler gy men)    270 - Gener al Liability ( Compr ehens iv e gener al liab. ( CGL) , ow ner s , landlor ds
                                                                                  and tenants ( OLT) manuf ac tur er s and c ontr ac tor s ( M&C) , c ompleted
                                                                                  oper ations , v ehic le s er v ic e c ontr ac ts ) other than ex c es s , XS or 261

280- Er r or s & Omis s ions ( dir ec tor s and of f ic er s , ins ur anc e       290 - Ex c es s liability ( umbr ella, XS, inc r eas ed limits liab.)
     agents , r eal es tate agents , public of f ic ials , tax pr epar er ,
     ar c hitec t)


300 - A c c ident & Health ( Inc luding Dis ability & Tr av el) , Stop Gap        310 - Other ( Rain, Hole- in- one, pr iz e indemnif ic ation, f r ee thr ow s , etc ., other )




                                                             Type of Transaction


A= A UDIT                                                                                                                                          C= CA NCELA TION

E= ENDORSEMENT                                                                                                                                     N= NEW

                                                                                 R= RENEWA L


                                            IF A, C, OR E IS USED, INDICA TE PREV IOUS Y EA RS PA GE OR LINE NUMBER.



word\ rax f oqm s \ c ov t y pe98. doc
R ev is ed 6. 02
                   STATEMENT OF INSURED

THIS FORM MUST BE COMPLETED IN DETAIL FOR EACH NEW RISK PLACED
AND FOR RENEWAL OF PREVIOUSLY PLACED RISKS. A COPY OF THIS
STATEMENT MUST BE PROVIDED TO THE INSURED AND MAINTAINED IN
AGENT’S FILES.

      INSURED:___________________________________________ COVERAGE TYPE:________

                                POLICY PERIOD:___/___/____ TO ___/___/____

As required by K.S.A. 40-246b, this will certify that I, the undersigned, have requested insurance coverage to be
placed on my behalf with a company that is non-admitted or licensed to transact business in the State of Kansas.
I understand that in accordance with K.S.A. 40-246b, that mere rate differential shall not be grounds for placing a
particular risk with a non-admitted company when an admitted company would accept such risk at a different
rate. It is further acknowledged that the following information regarding placement of insurance with a non-
admitted company, has been provided by the licensed excess lines agent:

         1.    The insurance coverage requested will be provided by an insurance company that is
               non-admitted or licensed to transact business in the State of Kansas, and whose name
               appears on the list of non-admitted companies maintained by the Commissioner of
               Insurance. The non-admitted insurers’ financial condition, policy forms, rates and trade
               practices are not subject to review or the jurisdiction of the Commissioner of Insurance.

         2.    There shall be no liability on the part of, and no cause of action of any nature shall arise
               against the Commissioner of Insurance, employees thereof, or the State of Kansas because
               the name of an insurance company appears or does not appear on the list of non-admitted
               companies maintained by the Commissioner of Insurance.

         3.    The policies or contracts of insurance issued by a non-admitted insurance company do
               not come under the protection afforded by the Kansas Insurance Guaranty Association
               Act (K.S.A. 40-2901, et seq.).

         4.    If the insurance company affording coverage is subsequently determined to be
               insolvent, the licensed excess lines agent placing such business with a company non-
               admitted to transact business in Kansas is, by giving you the information contained
               herein, relieved of any responsibility to the insured as it relates to such solvency.

         5.    Premium tax in the amo unt equal to 6% of the gross premiums shall be collected from
               insured and remitted to the Commissioner of Insurance by licensed agent.



___________________________________ ___________________________________ ____________
         Insured                                 Agent                   Date Signed


I was unavailable or otherwise unable to sign this statement prior to the effective date of coverage.



___________________________________ ___________________________________ ____________
         Insured                                 Agent                    Date Signed


Form ECA -D
REVISED 2.03
CoCode                               Company
902140   ACE SEGURO S.A.
44776    ALEA NORTH AMERICA SPECIALTY INSURANCE COMPANY
         ALLIANZ MARINE & AVIATION VERSICHERUNGS-
902008   AKTIENGESELLSCHAFT
33103    AMERICAN SAFETY INSURANCE COMPANY
902034   ASPEN INSURANCE UK LIMITED
42846    ATLANTIC CASUALTY INSURANCE COMPANY
901783   AXA CORPORATE SOLUTIONS ASSURANCE
902139   AXIS SPECIALTY EUROPE LIMITED
902142   BERKSHIRE HATHAWAY INTERNATIONAL INSURANCE LIMITED
902035   CATLIN INSURANCE COMPANY LTD
902104   CONVERIUM INSURANCE (UK) LIMITED
902007   ENDURANCE SPECIALTY INSURANCE LTD.
902036   EXPORTERS INSURANCE COMPANY LTD
14249    FOUNDERS INSURANCE COMPANY
902141   GARD MARINE & ENERGY
901807   IF P & C INSURANCE LTD. (PUBL)
37745    INTEGON SPECIALTY INSURANCE COMPANY
901978   LANTANA INSURANCE LTD.
902010   MONTPELIER REINSURANCE LTD
902071   NEWBURY INSURANCE COMPANY, LIMITED
27740    NORTH POINTE INSURANCE COMPANY
10786    PRINCETON EXCESS AND SURPLUS LINES INSURANCE COMPANY
34487    PROFESSIONAL UNDERWRITERS LIABILITY INSURANCE COMPANY
11515    QBE SPECIALTY INSURANCE COMPANY
11446    QUANTA SPECIALTY LINES INS CO
10179    RED MOUNTAIN CASUALTY INS CO INC
10981    RELIANT AMERICAN INSURANCE COMPANY
40479    REPUBLIC-VANGUARD INSURANCE COMPANY
10729    SENECA SPECIALTY INSURANCE COMPANY INC
         THROUGH TRANSPORT MUTUAL INSURANCE ASSN (EURASIA)
902072   LIMITED
         THROUGH TRANSPORT MUTUAL INSURANCE ASSOCIATION
902072   (EURASIA) LIMITED
         UNITED KINGDOM MUTUAL STEAM SHIP ASSURANCE ASSOCIATION
901869   (BERMUDA) LIMITED (aka UK P&I CLUB)
43451    UTICA SPECIALTY RISK INSURANCE COMPANY
902073   WIND RIVER INSURANCE COMPANY, LTD.
901332   ASSOCIATED ELECTRIC & GAS INS. SERVICES LTD (AEGIS)
901337   BRITISH AVIATION INSURANCE COMPANY LTD, THE
901378   CGU INTERNATIONAL INSURANCE plc
901379   COMMONWEALTH INSURANCE COMPANY
901331   ALLIANZ MARINE & AVIATION (FRANCE)
901385   GENERALI ASSURANCES IARD
         GENERALI, ASSICURAZIONI GENERALI, S.P.A., A/K/A GENERALI
901383   ASSICURAZIONI GENERALI DI TRIESTE
901338   HEDDINGTON INSURANCE (U.K.) LIMITED
901340   INDEMNITY MARINE ASSURANCE COMPANY LTD
901341   ACE EUROPEAN GROUP LIMITED
         LLOYD'S, UNDERWRITERS AT, LONDON, SPONSORING SYNDICATES
901344   SEE ATTACHED LISTING OF SPONSORING SYNDICATES
901346   MARINE INSURANCE COMPANY LIMITED, THE
901349   NORTHERN ASSURANCE COMPANY LIMITED, THE
901350   OCEAN MARINE INSURANCE COMPANY LIMITED
901365   MARKEL INTERNATIONAL INSURANCE COMPANY LIMITED
901367   GE SPECIALTY INSURANCE (UK) LIMITED
901373   ZURICH INTERNATIONAL (BERMUDA) LTD.
39020    ESSEX INSURANCE COMPANY
901345   LONDON & EDINBURGH INSURANCE COMPANY LIMITED
39381    ADRIATIC INSURANCE COMPANY
20079    NATIONAL FIRE & MARINE INSURANCE COMPANY
37974    MT HAWLEY INSURANCE COMPANY
31127    COLUMBIA CASUALTY COMPANY
39608    NUTMEG INSURANCE COMPANY
19437    LEXINGTON INSURANCE COMPANY
27189    ASSOCIATED INTERNATIONAL INSURANCE COMPANY
36420    ALLIANZ UNDERWRITERS INSURANCE COMPANY
37338    PACIFIC INSURANCE COMPANY
13064    UNITED NATIONAL INSURANCE COMPANY
22829    INTERSTATE FIRE & CASUALTY COMPANY
27790    CANAL INDEMNITY COMPANY
10046    PACIFIC INSURANCE COMPANY, LIMITED
38261    HARTFORD INSURANCE COMPANY OF THE S.E.
33189    MONTICELLO INSURANCE COMPANY
24856    ADMIRAL INSURANCE COMPANY
35351    AMERICAN EMPIRE SURPLUS LINES INS. CO. (THE)
33138    LANDMARK AMERICAN INSURANCE COMPANY
37982    TUDOR INSURANCE COMPANY
13196    WESTERN WORLD INSURANCE COMPANY INC
27960    ILLINOIS UNION INSURANCE COMPANY
27987    NORTHFIELD INSURANCE COMPANY
10316    APPALACHIAN INSURANCE COMPANY
35947    MT. McKINLEY INSURANCE COMPANY
37362    GENERAL STAR INDEMNITY COMPANY
35378    EVANSTON INSURANCE COMPANY
26743    MAXUM INDEMNITY COMPANY
21334    EMPIRE INDEMNITY INSURANCE COMPANY
36838    GENERAL AGENTS INSURANCE COMPANY OF AMERICA INC
30481    ST. PAUL SURPLUS LINES INSURANCE COMPANY
37532    GREAT AMERICAN E & S INSURANCE COMPANY
25054    HUDSON INSURANCE COMPANY
09989    INEX INSURANCE EXCHANGE
15466    REALM NATIONAL INSURANCE COMPANY
41858    GREAT AMERICAN FIDELITY INSURANCE COMPANY
32808    ILLINOIS EMCASCO INSURANCE COMPANY
19607    XL SELECT INSURANCE COMPANY
38989    CHUBB CUSTOM INSURANCE COMPANY
41807    ROYAL SURPLUS LINES INSURANCE COMPANY
42374    HOUSTON CASUALTY COMPANY
26387    STEADFAST INSURANCE COMPANY
901372   YORKSHIRE INSURANCE COMPANY LIMITED
39462    NORTH POINTE CASUALTY INSURANCE COMPANY
26620    AXIS SURPLUS INSURANCE COMPANY
26522    MOUNT VERNON FIRE INSURANCE COMPANY
15440    FINANCIAL BENEFITS INSURANCE COMPANY
17370    NAUTILUS INSURANCE COMPANY
28053    UNITED COASTAL INSURANCE COMPANY
36285    UNITED AMERICAS INSURANCE COMPANY
25445    TIG SPECIALTY INSURANCE COMPANY
36781    HCC INSURANCE COMPANY
11100    SAFECO SURPLUS LINES INSURANCE COMPANY
17159    USF INSURANCE COMPANY
11673    REDWOOD FIRE & CASUALTY INSURANCE COMPANY
38237    AMERICAN COUNTRY INSURANCE COMPANY
37150    WESTERN HERITAGE INSURANCE COMPANY
23850    PHILADELPHIA INSURANCE COMPANY
23620    BURLINGTON INSURANCE COMPANY (THE)
25569    GOTHAM INSURANCE COMPANY
39640    FIREMANS FUND INSURANCE COMPANY OF OHIO
26883    AMERICAN INTERNATIONAL SPECIALTY LINES INS. CO.
41297    SCOTTSDALE INSURANCE COMPANY
24317    ZC SPECIALTY INSURANCE COMPANY
41718    TRADERS & PACIFIC INSURANCE COMPANY
901364   SUNDERLAND MARINE MUTUAL INSURANCE COMPANY LTD
18376    HERMITAGE INSURANCE COMPANY
901440   GREAT LAKES REINSURANCE (U.K.) PLC
15610    AXIS SPECIALTY INSURANCE COMPANY
40428    VOYAGER INDEMNITY INSURANCE COMPANY
34568    CENTENNIAL CASUALTY COMPANY
36951    CENTURY SURETY COMPANY
901374   ZURICH SPECIALTIES LONDON LIMITED
34991    GENESIS INDEMNITY INSURANCE COMPANY
34916    FIRST SPECIALTY INSURANCE CORPORATION
901342   INTERNATIONAL INSURANCE CO. OF HANNOVER LIMITED
38580    GREAT AMERICAN PROTECTION INSURANCE COMPANY
34118    COLONY NATIONAL INSURANCE COMPANY
43117    AMERICAN EQUITY INSURANCE COMPANY
11622    SPECIALTY SURPLUS INSURANCE COMPANY
901384   ENERGY INSURANCE MUTUAL LIMITED
35912    AMERICAN WESTERN HOME INSURANCE COMPANY
22217    GULF UNDERWRITERS INSURANCE COMPANY
39993    COLONY INSURANCE COMPANY
31143    OLD REPUBLIC UNION INSURANCE COMPANY
15989    WELLINGTON SPECIALTY INS CO
10673    PENN-STAR INSURANCE COMPANY
901343   LIBERTY MUTUAL INSURANCE EUROPE LIMITED
25038    NORTH AMERICAN CAPACITY INSURANCE COMPANY
24319    ULICO INDEMNITY COMPANY
36056    NIC INSURANCE COMPANY
901370   WURTTEMBERGISCHE VERSICHERUNG AG
901355   QBE INTERNATIONAL INSURANCE LIMITED
901360   SR INTERNATIONAL BUSINESS INSURANCE COMPANY LTD
20559    GENERAL SECURITY INDEMNITY COMPANY OF ARIZONA
19489    ALLIED WORLD ASSURANCE COMPANY (U.S.) INC.
51616    CAPITOL SPECIALTY INSURANCE CORPORATION
10172    WESTCHESTER SURPLUS LINES INSURANCE COMPANY
17400    NOETIC SPECIALTY INSURANCE COMPANY
44792    EXECUTIVE RISK SPECIALTY INSURANCE COMPANY
10182    USF&G SPECIALTY INSURANCE COMPANY
12203    JAMES RIVER INSURANCE COMPANY
43095    CLARENDON AMERICA INSURANCE COMPANY
21199    ARCH SPECIALTY INSURANCE COMPANY
36940    INDIAN HARBOR INSURANCE COMPANY
27502    WESTERN GENERAL INSURANCE COMPANY
25433    AMERICAN SAFETY INDEMNITY COMPANY
37079    HUDSON SPECIALTY INSURANCE COMPANY
29696    TRAVELERS EXCESS & SURPLUS LINES COMPANY
34452    HOMELAND INSURANCE COMPANY OF NEW YORK
901389   GLENCOE INSURANCE LTD
10657    FIRST MECURY INSURANCE COMPANY
10717    ASPEN SPECIALTY INSURANCE COMPANY
10725    LIBERTY SURPLUS INSURANCE CORPORATION
10851    EVEREST INDEMNITY INSURANCE COMPANY
38920    AMERICAN HEALTHCARE SPECIALTY INSURANCE COMPANY
901390   SIRIUS INTERNATIONAL INSURANCE CORPORATION
901348   NORTH ROCK INSURANCE COMPANY LIMITED
44520    CRUM & FORSTER SPECIALTY INSURANCE COMPANY
10833    GEMINI INSURANCE COMPANY
901499   ALEA LONDON LIMITED
10213    DISCOVER SPECIALTY INSURANCE COMPANY
10946    ARCH EXCESS & SURPLUS INSURANCE COMPANY
10956    GULIFORD INSURANCE COMPANY
29629    NAMIC INSURANCE COMPANY INC
10932    STARR EXCESS LIABILITY INSURANCE COMPANY LTD
Syndicate    Exceptions to
 Number          Listing          Listed
   33                            8/1/1995
   190                           8/1/1995
   282                           8/1/1995
   318                           8/1/1995
   382                           8/1/1995
   435                           8/1/1995
   457                           8/1/1995
   510                           8/1/1995
   557                           8/1/1995
   566                           8/1/1995
   570                           8/1/1995
   609                           8/1/1995
   623                           8/1/1995
   727                           8/1/1995
   780                           8/1/1995
   807                           8/1/1995
   839                           8/1/1995
   958                           8/1/1995
   994                           8/1/1995
  1003    2002 year only*        8/1/1995
  1007                           8/1/1995
  1036                           8/1/1995
  1084                           8/1/1995
  1096                           8/1/1995
  1176                           8/1/1995
  1183                           8/1/1995
  1200                          10/1/2002
  1204                           1/1/2000
  1206                           1/1/1996
  1209                           1/1/1996
  1218                          10/1/1996
  1221                           1/1/1996
  1225                           1/1/1999
  1243                           1/1/1998
  1245                           1/1/2000
  1301                           1/1/2001
  1400                           1/1/2000
  1414                           1/1/2002
  1607                          10/1/1998
  1861                           1/1/2000
  2000    Incidental to #2999    1/1/2000
  2001                           1/1/2001
  2003                           1/1/1996
  2010                           7/1/2003
  2020                           1/1/1999
  2121                           1/1/2000
          Renumbered from
  2147    1415                  1/1/2001
  2488                          8/1/1995
2607                          1/1/2001
2623                          1/1/2003
2724   Incidental to #2999    1/1/1996
2791                          1/1/2001
2987                          1/1/2002
3000                          1/1/2002
3030   2002 year only*        7/1/2002
3210                          1/1/2003

4000                         12/31/2004

4444                         12/31/2003

4472                         12/31/2004
       Renumbered from
5000   1211                   1/1/2003
                    Non Admitted Company Changes Taking Place Calendar Year 2004

NAIC #           Name of Company                        Type of Change              Action Taken     Date

 37079 Hudson Specialty Insurance Company      FKA: General Security Indemnity Co    Renamed       12/29/2003
 39462 North Pointe Casualty Ins Co            FKA:Queensway Int'l Ind Co            Renamed       3/11/2004
 11446 Quanta Specialty Lines Ins Co           Addition                               Added         4/5/2004
 44776 Alea North Amerca Specialty Ins Co      Addition                               Added         4/9/2004
902104 Converium Insurance (UK) Limited        Addition                               Added         4/1/2004
       Lloyd's Syndicate #2, 183, 187, 227,
901344 314, 340, 397, 1411, 1511, 1611, 2011  Deletion                                Deleted       4/1/2004
                                              FKA: Wind River Ins. Co.
902073 Wind River Ins. Co., LTD               (Bermuda), LTD                         Renamed       5/12/2004
901385 Generali Assurances IARD               FKA: Generali-France Assurances        Renamed       6/14/2004
910362 Through Transport Mutual Ins Assn Ltd Deletion                                 Deleted      6/21/2004
901344 Lloyd's Syndicates #588 & 861          Deletion                                Deleted       7/1/2004
 14249 Founders Ins Co                        Addition                                Added         7/6/2004
 10179 Red Mountain Casualty Ins Co, Inc.     Addition                                Added         7/7/2004
 40479 Republic-Vanguard Ins Co               Addition                                Added        8/16/2004
 10940 Kemper Surplus Lines Ins Co            Deletion, Merged into American          Deleted      8/31/2004
 36781 HCC Insurance Company                  FKA: Centris Ins Co                    Renamed        9/1/2004
901341 ACE European Group Limited             FKA: ACE INA UK Limited                Renamed       9/13/2004
902140 ACE Seguros, S.A.                      Addition                                Added        10/1/2004
902139 AXIS Specialty Europe Limited          Addition                                Added        10/1/2004
       Berkshire Hathaway International
902142 Insurance Limited                      Addition                                Added        10/1/2004
902141 Gard Marine & Energy Limited           Addition                                Added        10/1/2004
 25542 TIG Ins Co of Michigan                 Deletion                                Deleted      10/31/2004
901361 St. Paul Reinsurance Limited           Deletion                                Deleted      11/22/2004
                                              FKA: Corporate Solutions Excess
 15989 Wellington Specialty Ins Co            And Surplus Lines Ins Co               Renamed       11/24/2004
901344 Lloyd's Syndicate #4000, 4472          Addition                                Added        12/31/2004
       Lloyd's Syndicate #102, 529, 582, 990,
901344 1211, 1241, 2323                       Deletion                                Deleted      12/31/2004

				
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