# Statistical Plan #37

**Named Insured:** [Name]
**Underwriter:** [Underwriter Name]
**Branch:** [Branch Name]
**Date:** [Date]

**Division/Department:** 2 Excess and Umbrella Modification of CSR Non-Surety

**Policy Type:** A-4
**Type Limit:** [Type Limit]
**Net:** [Net]
**Underwriting Limit:** [Underwriting Limit]

**Individual Sur Rate Modification Factor:**
- EXP: [EXP]
- Sched: [Sched]
- Pack: [Pack]
- EXP: [EXP]
- COMM.: [COMM.]
- DED.: [DED.]

**Major Class:**
- 1. BI (OTT Auto): [0052]
- 2. BI (OTT Auto): [0053]
- 3. BI (Auto): [0056]
- 4. BI (Auto): [0057]
- 5. Professionals: [0012]
- 6. Medical Prof.: [0059]
- 7. Products (III): [0072]
- 8. Products (IV): [0073]
- 9. P.V.C.: [0074]

**Premiums:**
- 1. BI (OTT Auto): [0052]
- 2. BI (OTT Auto): [0053]
- 3. BI (Auto): [0056]
- 4. BI (Auto): [0057]
- 5. Professionals: [0012]
- 6. Medical Prof.: [0059]
- 7. Products (III): [0072]
- 8. Products (IV): [0073]
- 9. P.V.C.: [0074]

**Additional Information:**
- [Additional Notes]