2012 Acknowledgment for Annual Calls for Experience

Acknowledgment Basic Detail                 Group/Carrier Code:   Group/Carrier Name:   Address:   City:   State: AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip:   Contact Information: First Name:   Last Name:   Title: Department: Email:     Telephone No: - - Extension: Group Reporting     Carriers within Group                 Carrier Calls                 CALL TYPE WILL REPORT NO EXPERIENCE TO REPORT P1 Policy Year Call for Compensation Experience Valued as of December 31, 2011—Due April 1, 2012 C1 Calendar-Accident Year Call for Compensation Experience Valued as of December 31, 2011—Due April 1, 2012 SR Supplemental Call for Schedule Rating Premium Adjustments—Due April 1, 2012 P2 Large Deductible Policy Year Call for Compensation Experience Valued as of December 31, 2011—Due April 1,2012 C2 Large Deductible Calendar-Accident Year Call for Compensation Experience Valued as of December 31,2011—Due April 1, 2012 RR Reconciliation Report for Calendar Year 2011 Data Call—Due April 1, 2012 LL Large Loss and Catastrophe Call Valued as of December 31,2011—Due April 1, 2012