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Ation Advisory Organization Reference Filing Number The above insurer hereby declares that it is a member, subscriber or service purchaser of the named advisory organization for this line of insurance. The insurer hereby files to be deemed to have independently submitted as its own filing, the prospective loss costs in the captioned Reference filing. The insurer's rates will be a combination of the prospective loss costs and the loss cost multipliers and, if utilized, the expense constants spec.

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