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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
STATE OF NEW MEXICO
OFFICE OF SUPERINTENDENT OF INSURANCE
DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.
DEPUTY SUPERINTENDENT
Andy Romero
SUPERINTENDENT OF INSURANCE