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STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE DEPUTY SUPERINTENDENT Robert E. Doucette, Jr. DEPUTY SUPERINTENDENT Andy Romero SUPERINTENDENT OF INSURANCE John G. Franchini Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us July 1, 2019 Attention: Please include in your addenda via Wire or ACH Credit: FA*25232*09012019*89*200.00 Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid. Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020 INVOICE #FA-0001 Due: September 1, 2019 21st Century Advantage Insurance Company 3 Beaver Valley Road Wilmington, DE 19803 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit. NAIC CoCode: 25232 Direct Premium Written $ 0.00 Total Assessment $ 200.00 Total Due: $ 200.00 Example Date: Please insert the date the payment is submitted.
Transcript of STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF … › wp-content › uploads › ... · OFFICE OF...
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*25232*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0001 Due: September 1, 2019
21st Century Advantage Insurance Company 3 Beaver Valley Road Wilmington, DE 19803 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 25232
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*44245*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0002 Due: September 1, 2019
21st Century Assurance Company 3 Beaver Valley Road Wilmington, DE 19803-1115 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 44245
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*36404*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0003 Due: September 1, 2019
21st Century Casualty Company 3 Beaver Valley Road Wilmington, DE 19803 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 36404
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*34789*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0004 Due: September 1, 2019
21st Century Centennial Insurance Company 3 Beaver Valley Road Wilmington, DE 19803 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 34789
Direct Premium Written $ -14,616.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*32220*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0005 Due: September 1, 2019
21st Century North America Insurance Company 3 Beaver Valley Road Wilmington, DE 19803 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 32220
Direct Premium Written $ 5,009.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*20796*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0006 Due: September 1, 2019
21st Century Premier Insurance Company 3 Beaver Valley Road Wilmington, DE 19803 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 20796
Direct Premium Written $ 1,926.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*80985*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0007 Due: September 1, 2019
4 Ever Life Insurance Company 2 Mid America Plaza, Suite 200 Oakbrook Terrance, IL 60181-4712 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 80985
Direct Premium Written $ 21,826
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*77879*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0008 Due: September 1, 2019
5 Star Life Insurance Company 909 North Washington Street Alexandria, VA 22314 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 77879
Direct Premium Written $ 1,249,658
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*71854*09012019*89*863.79
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0009 Due: September 1, 2019
AAA Life Insurance Company 17900 North Laurel Park Drive Livonia, MI 48152 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 71854
Direct Premium Written $ 5,508,864
Total Assessment $ 863.79
Total Due:
$ 863.79
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*71471*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0010 Due: September 1, 2019
Ability Insurance Company c/o Tri-Plus Services, 35 Parkwood Drive, Suite 150 Hopkinton, MA 01748 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 71471
Direct Premium Written $ 564,264
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*22896*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0011 Due: September 1, 2019
ACA Financial Guaranty Corporation 555 Theodore Fremd Avenue, Suite C-205 Rye, NY 10580 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 22896
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*12934*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0012 Due: September 1, 2019
Academic Medical Professionals Insurance Risk Retention Group, LLC 76 St. Paul Street, Suite 500 Burlington, VT 05401 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 12934
Direct Premium Written $ 4,426.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*31325*09012019*89*341.77
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0013 Due: September 1, 2019
Acadia Insurance Company PO Box 9010 Des Moines, IA 50306 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 31325
Direct Premium Written $ 2,179,636
Total Assessment $ 341.77
Total Due:
$ 341.77
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*10807*09012019*89*836.33
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0014 Due: September 1, 2019
ACCC Insurance Company 390 Benmar Drive, Suite 225 Houston, TX 77060 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 10807
Direct Premium Written $ 5,333,748
Total Assessment $ 836.33
Total Due:
$ 836.33
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*63444*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0015 Due: September 1, 2019
Accendo Insurance Company 2211 Sanders Road Northbrook, IL 60062 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 63444
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*11711*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0016 Due: September 1, 2019
Access Insurance Company PO Box 105259 Atlanta, GA 30348 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 11711
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*12304*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0017 Due: September 1, 2019
Accident Fund General Insurance Company PO Box 40790 Lansing, MI 48901-7990 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 12304
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*10166*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0018 Due: September 1, 2019
Accident Fund Insurance Company of America PO Box 40790 Lansing, MI 48901 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 10166
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*12305*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0019 Due: September 1, 2019
Accident Fund National Insurance Company PO Box 40790 Lansing, MI 48901-7990 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 12305
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*11573*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0020 Due: September 1, 2019
Accident Insurance Company, Inc. One Harbison Way, Suite 115 Columbia, SC 29212 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 11573
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*62200*09012019*89*222.67
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0021 Due: September 1, 2019
Accordia Life and Annuity Company 215 10th Street, Suite 1100 Des Moines, IA 50309 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 62200
Direct Premium Written $ 1,420,080
Total Assessment $ 222.67
Total Due:
$ 222.67
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*26379*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0022 Due: September 1, 2019
Accredited Surety and Casualty Company, Inc. P O Box 140855 Orlando, FL 32814 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 26379
Direct Premium Written $ 691.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*22667*09012019*89*1,651.72
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0023 Due: September 1, 2019
ACE American Insurance Company 436 Walnut Street Philadelphia, PA 19106 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 22667
Direct Premium Written $ 10,533,910
Total Assessment $ 1,651.72
Total Due:
$ 1,651.72
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*20702*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0024 Due: September 1, 2019
ACE Fire Underwriters Insurance Company 436 Walnut Street Philadelphia, PA 19106 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 20702
Direct Premium Written $ 227,905
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*60348*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0025 Due: September 1, 2019
ACE Life Insurance Company 436 Walnut Street Philadelphia, PA 19106 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 60348
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*20699*09012019*89*802.57
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0026 Due: September 1, 2019
ACE Property and Casualty Insurance Company 436 Walnut Street Philadelphia, PA 19106 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 20699
Direct Premium Written $ 5,118,419
Total Assessment $ 802.57
Total Due:
$ 802.57
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*19984*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0027 Due: September 1, 2019
ACIG Insurance Company 2600 North Central Expressway, Suite 800 Richardson, TX 75080 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 19984
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*22950*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0028 Due: September 1, 2019
ACSTAR Insurance Company 30 South Road Farmington, CT 06032 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 22950
Direct Premium Written $ 48,954
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*14184*09012019*89*2,982.44
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0029 Due: September 1, 2019
ACUITY, A Mutual Insurance Company PO Box 58 Sheboygan, WI 53082 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 14184
Direct Premium Written $ 19,020,694
Total Assessment $ 2,982.44
Total Due:
$ 2,982.44
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*33987*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0030 Due: September 1, 2019
ADM Insurance Company 76 St. Paul Street, Suite 500 Burlington, VT 05401 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 33987
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*44318*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0031 Due: September 1, 2019
Admiral Indemnity Company PO Box 9190 Des Moines, IA 50306-9190 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 44318
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*39381*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0032 Due: September 1, 2019
Adriatic Insurance Company 3501 North Causeway Boulevard, Suite 1000 Metairie, LA 70002-3675 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 39381
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*40517*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0033 Due: September 1, 2019
Advantage Workers Compensation Insurance Company PO Box 571918 Salt Lake City, UT 84157-1918 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 40517
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*33898*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0034 Due: September 1, 2019
Aegis Security Insurance Company PO Box 3153 Harrisburg, PA 17105 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 33898
Direct Premium Written $ 497,910
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*16072*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0035 Due: September 1, 2019
Aetna Better Health of Kansas Inc. 3721 Tecport Drive Harrisburg, PA 17106 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 16072
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*78700*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0036 Due: September 1, 2019
Aetna Health and Life Insurance Company 151 Farmington Avenue, RT21 Hartford, CT 06156 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 78700
Direct Premium Written $ 24,099
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*72052*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0037 Due: September 1, 2019
Aetna Health Insurance Company 3721 Tecport Drive Harrisburg, PA 17111 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 72052
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*36153*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0038 Due: September 1, 2019
Aetna Insurance Company of Connecticut 151 Farmington Avenue, RT21 Hartford, CT 06156 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 36153
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*60054*09012019*89*21,451.11
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0039 Due: September 1, 2019
Aetna Life Insurance Company 151 Farmington Avenue, RT21 Hartford, CT 06156 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 60054
Direct Premium Written $ 136,805,531
Total Assessment $ 21,451.11
Total Due:
$ 21,451.11
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*35963*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0040 Due: September 1, 2019
AF&L INS CO 580 Virginia Drive, Suite 330 Fort Washington, PA 19034 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 35963
Direct Premium Written $ 8,232.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*10014*09012019*89*462.05
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0041 Due: September 1, 2019
Affiliated FM Insurance Company PO Box 7500 Johnson, RI 02919 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 10014
Direct Premium Written $ 2,946,771
Total Assessment $ 462.05
Total Due:
$ 462.05
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*13677*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0042 Due: September 1, 2019
Affiliates Insurance Reciprocal, a Risk Retention Group 30 Main Street, Suite 330 Burlington, VT 05401 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 13677
Direct Premium Written $ 6,039.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*42609*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0043 Due: September 1, 2019
Affirmative Insurance Company 4450 Sojourn Drive, Suite 500 Addison, TX 75001-5084 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 42609
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*22837*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0044 Due: September 1, 2019
AGCS Marine Insurance Company 1465 North McDowell Boulevard Petaluma, CA 94954 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 22837
Direct Premium Written $ 718,682
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*10389*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0045 Due: September 1, 2019
AGENT ALLIANCE INS CO P O Box 3199 Winston-Salem, NC 27105-3199 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 10389
Direct Premium Written $ 26,065
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*12522*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0046 Due: September 1, 2019
Agents National Title Insurance Company 1207 West Broadway Street, Suite C Columbia, MO 65203 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 12522
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*42757*09012019*89*272.76
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0047 Due: September 1, 2019
Agri General Insurance Company 436 Walnut Street Philadelphia, PA 19106 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 42757
Direct Premium Written $ 1,739,536
Total Assessment $ 272.76
Total Due:
$ 272.76
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*40258*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0048 Due: September 1, 2019
AIG Assurance Company 175 Water Street, 18th Floor New York, NY 10038 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 40258
Direct Premium Written $ -186.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*19402*09012019*89*448.77
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0049 Due: September 1, 2019
AIG Property Casualty Company 175 WaterStreet, 18th Floor New York, NY 10038 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 19402
Direct Premium Written $ 2,862,075
Total Assessment $ 448.77
Total Due:
$ 448.77
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA**09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0050 Due: September 1, 2019
AIG Seguros Mexico, S.A. de C.V. Insurgentes Sur 1136 Mexico City, UN 03200 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode:
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*26883*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0051 Due: September 1, 2019
AIG SPECIALTY INS CO 175 Water Street, 18th Floor New York, NY 10038 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 26883
Direct Premium Written $ 966,691
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*19399*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0052 Due: September 1, 2019
AIU Insurance Company 175 Water Street, 18th Floor New York, NY 10038 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 19399
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*12833*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0053 Due: September 1, 2019
AIX SPECIALTY INS CO 440 Lincoln Street Worchester, MA 01653 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 12833
Direct Premium Written $ 798,965
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
-
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*10957*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0054 Due: September 1, 2019
Alamance Insurance Company 185 Asylum Street, 7th Floor, City Place II Hartford, CT 06103 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 10957
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*50598*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0055 Due: September 1, 2019
Alamo Title Insurance 601 Riverside Avenue Jacksonville, FL 32204 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 50598
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*38733*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0056 Due: September 1, 2019
Alaska National Insurance Company 7001 Jewel Lake Road Anchorage, AK 99502 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 38733
Direct Premium Written $ 5,736.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*24899*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0057 Due: September 1, 2019
Alea North America Insurance Company 5 Batterson Park Road, 3rd Floor Farmington, CT 06032 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 24899
Direct Premium Written $ 0.00
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
John G. Franchini
Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110
Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us
July 1, 2019
Attention: Please include in your addenda via Wire or ACH Credit:
FA*20222*09012019*89*200.00
Pursuant to Section 59A-16C-14B NMSA 1978: The fee shall be due annually pursuant to rules promulgated by the superintendent. The failure of an insurer to pay this fee when due shall subject the insurer to a penalty of one thousand dollars ($1,000) per month or part thereof in which the fee remains unpaid.
Annual Fraud Assessment Assessment Year: July 1, 2019 – June 30, 2020
INVOICE #FA-0058 Due: September 1, 2019
All America Insurance Company 800 South Washington Street Van Wert, OH 45891 Important: Checks are no longer accepted. Payments must be submitted via Wire or ACH Credit.
NAIC CoCode: 20222
Direct Premium Written $ 39,225
Total Assessment $ 200.00
Total Due:
$ 200.00
Example Date: Please insert the date the payment is submitted.
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STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE
