EOED-DOI

Disaster Contact Information

NAIC Company Group Number(Required)

NAIC Company Group Name(Required)

Survey Response Prepared By(Required)

First Last

Preparer Email(Required)

Detailed Data Collection Contact(s)

Individual(s) responsible for providing company data to the division of Insurance.
This data is requested by the Division under provisions of DOI Bulletin 2016-10.
The maximum number of contacts is three per insurer group.

Data Collection Contact 1 Name(Required)

First Last

Data Collection Contact 1 Title(Required)

Data Collection Contact 1 Email(Required)

Data Collection Contact 1 Cell Phone(Required)

Data Collection Contact 1 Office Phone(Required)

Data Collection Contact 2 Name

First Last

Data Collection Contact 2 Title

Data Collection Contact 2 Email

Data Collection Contact 2 Cell Phone

Data Collection Contact 2 Office Phone

Data Collection Contact 3 Name

First Last

Data Collection Contact 3 Title

Data Collection Contact 3 Email

Data Collection Contact 3 Cell Phone

Data Collection Contact 3 Office Phone

Insurance Claims Manager Contact(s)

Individual(s) responsible for the deployment of insurance company claims personnel following a disaster.
The maximum number of contacts is three per insurer group.

Insurance Claims Manager 1 Name(Required)

First Last

Insurance Claims Manager 1 Title(Required)

Insurance Claims Manager 1 Email(Required)

Insurance Claims Manager 1 Cell Phone(Required)

Insurance Claims Manager 1 Office Phone(Required)

Insurance Claims Manager 2 Name

First Last

Insurance Claims Manager 2 Title

Insurance Claims Manager 2 Email

Insurance Claims Manager 2 Cell Phone

Insurance Claims Manager 2 Office Phone

Insurance Claims Manager 3 Name

First Last

Insurance Claims Manager 3 Title

Insurance Claims Manager 3 Email

Insurance Claims Manager 3 Cell Phone

Insurance Claims Manager 3 Office Phone

Insurance Company Communications Contact(s)

Individual(s) responsible for corporate monitoring and public communication of disaster claim values and insurer response efforts.
The maximum number of contacts is three per insurance group.

Insurance Company Communications Contact 1 Name(Required)

First Last

Insurance Company Communications Contact 1 Title(Required)

Insurance Company Communications Contact 1 Email(Required)

Insurance Company Communications Contact 1 Cell Phone(Required)

Insurance Company Communicatiopns Contact 1 Office Phone(Required)

rance

Insurance Company Communications Contact 2 Name

First Last

Insurance Company Communications Contact 2 Title

Insurance Company Communications Contact 2 Email

Insurance Company Communications Contact 2 Cell Phone

Insurance Company Communications Contact 2 Office Phone

Insurance Company Communications Contact 3 Name

First Last

Insurance Company Communications Contact 3 Title

Insurance Company Communications Contact 3 Email

Insurance Company Communications Contact 3 Cell Phone

Insurance Company Communications Contact 3 Office Phone

Claimant Contact Information

Toll-Free Claim Reporting Phone Number(Required)

Company Website Claim Information

Basic Exposure Information

This section allows for the providing of the total insurer group surplus as of the end of the previous calendar year, and the amount of insurance and policy counts for each Massachusetts county as of the end of the previous calendar year.

Baseline information regarding property loss exposure is required for insurer groups with market share based on direct written premium greater than 0.5% in the calendar year ending December 31, 2025 for the NAIC lines of business 01 (Fire) & 02.1 (Allied Lines), and 04 (Homeowners Multi Peril on a combined basis. If the company has nothing to report for certain lines of insurance, please enter "0". All data elements shall reflect in-force values as of December 31, 2025. All results are to be reported on a group basis, not individually for different companies within the same insurer group.

Data Element 1: Surplus as regards policyholders

(report to the nearest $1000(Required)

Data Element 2 : Total Insured Value of Coverage A and C (report to the nearest $1000) by County

Barnstable

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Berkshire

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Bristol

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Dukes

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Essex

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Franklin

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Hampden

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)

Hampshire

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Middlesex

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Nantucket

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Norfolk

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Plymouth

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Suffolk

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)

Worcester

Fire/Allied Lines(Required)

Homeowner/Multi Peril(Required)

(Non-Liability) Comm. Multi Peril (Total Limit Only)(Required)