Compliance with the Provisions of Section 19-104(c) of the Insurance Article

2. Complete, sign, date and return by August 18, 2013 the attached form to acknowledge this Bulletin and the company’s obligation to file compliant rates and forms on or before September 30, 2013. If any company has filings that are compliant as well as filings that are not, please complete both sections of the form. Failure to certify compliance and/or acknowledge the Bulletin may result in administrative action. The forms should be returned to: Geoffrey Cabin, Director of P & C Rates and Forms at Geoffrey.cabin@maryland.gov or Maryland Insurance Administration 200 St. Paul Place Suite 2700 Baltimore, MD 21202 If there are any questions, Mr. Cabin can be reached at 410-468-2310. Therese M. Goldsmith Insurance Commissioner By: Sandra Castagna Associate Commissioner Property and Casualty Signature on original SECTION 19-104(C) of the INSURANCE ARTICLE CERTIFICATION OF COMPLIANCE/ACKNOWLEDGMENT FORM Please provide the following information: Name of Insurance Company _____________________________________________ List all SERFF filing numbers containing rates and forms that comply with Section 19-104(c) of the Insurance Article. Attach additional sheets, if necessary. The company acknowledges receipt of this Bulletin and understands its obligation to file rates and forms that comply with Section 19-104(c) of the Insurance Article on or before September 30, 2013 to amend its filings with the following SERFF numbers: Certification of Compliance Statement The response provided is, to the best of my knowledge, information, and belief, a full, complete, and truthful response to the Commissioner’s request; and in making the certification, I have undertaken an adequate inquiry to make the required certification. Company Officer:_______________________________ Signature:_____________________________________ Date Signed:___________________________________