# Initial Statement of Adjustment

**DocuSign Envelope ID:** 36857BF5-BFB0-4F33-ACA9-8EE38BEA37BB  
**Chubb Global Casualty**

## General Liability

**HDO G7296360A**

| State | Estimated Policy Premium ($) | Initial AARO Adjustment ($) | Total Estimated Written Premium ($) |
|-------|------------------------------|------------------------------|------------------------------------|
| Alabama | 461 | 598 | 1,059 |
| Arizona | 921 | 1,145 | 2,066 |
| Arkansas | 586 | 846 | 1,432 |
| California | 1,132 | 6,817 | 7,949 |
| Colorado | 1,564 | 1,935 | 3,499 |
| Florida | 6,904 | 0 | 6,904 |
| Georgia | 1,138 | 1,554 | 2,692 |
| Idaho | 1,115 | 1,431 | 2,546 |
| Illinois | 1,942 | 2,383 | 4,325 |
| Indiana | 1,286 | 1,568 | 2,854 |
| Kansas | 416 | 508 | 924 |
| Kentucky | 355 | 410 | 765 |
| Louisiana | 2,835 | 4,108 | 6,943 |
| Maryland | 1,308 | 1,611 | 2,919 |
| Michigan | 809 | 892 | 1,701 |
| Minnesota | 1,024 | 1,215 | 2,239 |
| Mississippi | 345 | 461 | 806 |
| Missouri | 782 | 946 | 1,728 |
| Montana | 729 | 1,061 | 1,790 |
| New Jersey | 1,566 | 2,044 | 3,610 |
| New Mexico | 427 | 598 | 1,025 |
| New York | 43,075 | 76,746 | 119,821 |
| North Carolina | 723 | 849 | 1,572 |
| Ohio | 288 | 336 | 624 |
| Oregon | 767 | 0 | 767 |
| South Carolina | 1,144 | 1,577 | 2,721 |
| Tennessee | 1,160 | 1,347 | 2,507 |
| Texas | 2,966 | 4,832 | 7,798 |
| Utah | 432 | 611 | 1,043 |
| Virginia | 2,025 | 0 | 2,025 |
| Washington | 892 | 966 | 1,858 |
| Wisconsin | 915 | 1,073 | 1,988 |
| **TOTALS** | **82,032** | **120,468** | **202,500** |

## Automobile Liability

**INTERNA_05212023_William Overby**  
**04/28/2023**  
**Initial Statement of Adjustment Page 24 of 55**