**STATISTICAL PLAN #37**

**NAMED INSURED:** [Name of Insured]
**UNDERWRITER:** [Underwriter Name]
**BRANCH:** NY 01
**DATE:** 1/25/91

**DIVISION 3, DEPARTMENT 2, EXCESS AND UMBRELLA MODIFICATION OF CSR NON-SUBEQUENT**

| STATE | RATING DATE | A | POLICY TYPE | GROSS LIMIT | NET LIMIT | UNDERWR. ERASER | BUS. LIMIT | UNDERWR. ERASER |
|-------|-------------|---|-------------|-------------|-----------|-----------------|------------|-----------------|
| 33    | 34          | M | Y | Y | 36 | 37 | 38 | 39 | 40 | 41 | 42 | 43 | 44 | 45 | 46 | 47 | 48 | 49 | 50 | 51 | 52 | 53 | 54 | 55 | 56 | 57 | 58 | 59 | 60 | 61 | 62 | 63 | 64 | 65 | 66 | 67 | 68 | 69 | 70 | 71 | 72 |
| 37    | 0 | 5 | 8 | 5 | 9 | 0 | 3 | 2 | 1 | 2 | 3 | 5 | 5 | 8 | 4 | 0 | 2 |

**INDIVIDUAL RISK RATE MODIFICATION FACTOR**

| EXPERT | SCHEDULED PACK | EXPERI. COMM. DEP. |
|--------|----------------|--------------------|
| A       | A               | A                  |

**TYPE** | **MAJOR CLASS** | **PREMIUM** | **TYPE** | **MAJOR CLASS** | **PREMIUM**
|---------|-----------------|--------------|----------|-----------------|--------------
| ☐ Workers' Compensation (Specs) | 1. BILOT Auto (077 Auto) | 14722.96 | ☐ Commercial Umbrella | 1.81 (077 Auto) | 0552 |
| ☐ Professional Liability (Exams) | 2. PD (077 Auto) | 14372.06 | ☐ Alcohol | 3.81 (Auto) | 0556 |
| ☐ Errors Lines | 3. BIJ (Auto) | 14722.96 | ☐ PD (Auto) | 4. PD (Auto) | 0557 |
| ☐ Errors Lines | 4. PD (Auto) | 14722.96 | ☐ Professional | 5. Professional | 0552 |
| ☐ Errors Lines | 5. Professional | 0012 | ☐ Medical Prof. | 6. Medical Prof. | 0559 |
| ☐ Errors Lines | 6. Medical Prof. | 0012 | ☐ Products (Pro) | 7. Products (Pro) | 0582 |
| ☐ Errors Lines | 7. Products (Pro) | 0014 | ☐ W.C. | 8. W.C. | 0014 |
| ☐ Errors Lines | 9. W.C. | 0014 | ☐ W.C. | 9. W.C. | 0014 |

**38543 (A 831)**