CERTIFICATION AS AN EXEMPT
COMMERCIAL POLICYHOLDER

Maryland Insurance Article §11-206 permits certain commercial policyholders to certify that the policyholder meets the criteria required to qualify as an Exempt Commercial Policyholder.  Certification as an Exempt Commercial Policyholder permits the policyholder to purchase insurance policies that contain forms and endorsements that have not been filed with and approved by the Maryland Insurance Administration.

In order to qualify as an Exempt Commercial Policyholder, you must meet the following criteria:
I.          Total premium for current calendar year or preceding calendar year must be      $75,000 or greater;

Are your Commercial Property and Casualty Premiums for Policies Issued in Maryland $75,000.00 or greater?   Yes ð  No ð

II.         And any two of the following (check all that apply):

q   Generates annual revenues or sales in excess of $10,000,000.
q   Possesses a net worth in excess of 5,000,000.
q   Employs at least 25 full-time employees.
q   Is a nonprofit organization or public body with an annual budget of at least 10,000,000.
q   Is a municipal corporation with a population of at least 15,000.

The undersigned commercial insurance policyholder acknowledges that the policy I am receiving from ______________________________ (Name of Insurance Company) may contain forms and/or endorsements that have not been filed with and approved by the Maryland Insurance Administration.

____________________________________

                                                         Signature of Authorized Representative /Date

____________________________________

                                                         Name and Title of Authorized Representative

____________________________________

                                                             Name of Commercial Insured

der/ECP June 2000.doc