аЯрЁБс>ўџ .0ўџџџ-џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС'` №Пчbjbj$š$š 5 F№F№Ъ џџџџџџЄ^^^^^^^r: : : 8r ~ rІюІ І М М М — ,У Я %''''''$”hќšK^Ÿ— — ŸŸK^^М М л`Ÿd^М ^М §(Ÿ%^^М š Зчf!Ь: pщv0І–sL––^Ьз vMTЁDхКз з з KKП^з з з ІŸŸŸŸrrr$– Єrrr– rrr^^^^^^џџџџ  STATE OF CALIFORNIA Department of Insurance APPLICATION FOR CERTIFICATE OF AUTHORITY MOTOR CLUB  Stage II We enclose the following forms to be used in connection with your application to transact business as a motor club in California: Application Form CCB42 Motor Club Checklist Motor Club Questionnaire Motor Club Bond Agent for Service of Process and Stipulation Form California Insurance Code Sections relating to Motor Clubs Biographical Affidavit Forms Bulletin No. 703 (Revised and Reissued 12/1/86) Authorization for Disclosure of Financial Records A biographical affidavit form must be completely filled out and duly executed by each officer, director and key managerial personnel of the motor club. Please note that the biographical affidavit form provides that "If answer is 'none' or 'No exceptions', so state." These affidavits should be carefully completed by the affiants and certified by each such affiant. If additional forms are required, Applicant may reproduce them by xerox or some other method. One copy of the Questionnaire should be completed and duly executed by an officer of the Applicant. Accidental death and dismemberment benefits, legal defense reimbursement benefits, and bail bond benefits must be provided to members of a motor club directly by an insurer; i.e., the insurer and not the motor club must assume the risk involved in these benefits. The providing of these benefits constitutes the transaction of insurance and must be provided under a policy of insurance underwritten by an admitted insurer. Although a bail bond benefit may be provided through an admitted insurer, a bail bond certificate is not acceptable by California courts and thus may not be offered in this State. Please include a detailed description and analysis of the Applicant's proposed plan of operation in the State of California, including samples of the contracts which it intends to issue, methods to be employed in the training and recruitment of its sales force, description of the method by which its accounting and bookkeeping records will be maintained in order to provide the periodic statements required by this Department, etc. The Applicant will have sixty (60) days from the date of this letter in which to submit a complete filing. If same is not provided within sixty (60) days, the file will be considered abandoned and the filing fee will be forfeited. Upon timely filing of a complete application, it will be reviewed in its entirety. If the review of the complete filing discloses fatal defects to admission, Applicant will be so informed and a request will be made to the Applicant to withdraw the application within thirty (30) days. If the Applicant does not do so within that period of time, the application will be denied. If the application reveals defects or deficiencies which may be corrected or overcome, the Applicant will be given thirty (30) days from the date of the Department's deficiency letter to do so. If the Applicant fails to conform within that period of time, the application will be deemed abandoned and the Department will take no further action on the file. No exception will be made. In all cases, if the Applicant again applies for admission, a new statutory filing fee will be imposed (see current fee schedule). The California Insurance Code may be purchased by ordering from West Publishing Company at 1-(800) 328-9352. Enclosures Doc. 0021f (Rev. 4/19/11) #677035v1     -PAGE 1- 12ЂhОПШЩЪЫЭЮабгджийопрсхцчёхёжЦжёжЗЄЗ•‰‰‰‰…}…}t}…‰•h—(:mHnHujh—(:Uh—(:hСgXjhСgXUhСhїчOJQJ^JaJ$hСhВ.0JCJOJQJ^JaJhСhВ.OJQJ^JaJhСhИ/y>*OJQJ^JaJhСhИ/yOJQJ^JaJhСOJQJ^JaJhСhСOJQJ^JaJF_`abŒЃЄЅІ( ) A V o    Д з ђ  @ яяйййяяйййййПППППППППП$ ЦPp@ рА€P„p`„pa$gdИ/y$ ЦPp@ рА€Pa$gdИ/y$ ЦHА€Pa$gdИ/yЪц§§@ r s B C Ї Ј ЗИ Ё#$•–—˜ЃЄОПЪхЯЯЯЯЯЯЯЯЯЯЯЯЯЯЯЯЯЯЯЯЭШgdВ.$ ЦPp@ рА€Pa$gdИ/y$ ЦPp@ рА€P„p`„pa$gdИ/yЪЬЭЯавгежуфхцч§§§§§§§§ѓу§§оgdВ. ЦPp@ рА€P ЦHА€P 30PBPАа/ Ар=!А "А # $ %АА А  а†œL@ёџL И/yNormal1$CJOJQJ_HhmH sH tH DA@ђџЁD Default Paragraph FontRiѓџГR  Table Normalі4ж l4жaі (kєџС(No List@ўOЂё@ И/yzzTrailerDocNameCJY(44 В.Header  ЦрР!4 4 В.Footer  ЦрР!ч џџџџF_`abŒЃЄЅІ()AVo Дзђ@rsBCЇЈЗИ  Ё # $ • – — ˜ Ѓ Є О П Ъ Ь Э Я а в г е ж у ф х ш ˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€˜0€€ˆб00–Ј‘00З˜@0€€Ј‘00З˜@0€€Ј‘00З˜@0€€Ј‘00З˜@0€€˜@0€€ша00АЈ‘00ш З˜ Ѓ Є О ш Š‘0А˜rˆ‘0ˆ‘0@Tі`Рš€€€ ч @ Ъч ц !”џ•€№8№@ёџџџ€€€ї№’№№0№( № №№B №S №ПЫџ ?№џџzzDocumentPositionш ш џџf8{dЄжg8{dЎh8{d$Џеi8{d<жj8{dЬУтk8{d<Єъl8{dЄЛџ m8{dм`г;;ДДШШш EE&&ООввш 9*€urn:schemas-microsoft-com:office:smarttags€place€9*€urn:schemas-microsoft-com:office:smarttags€State€ бR&+Ъ Ъ Ь Ь Э Э Я а в г е ж х ш ктр ‚ Ъ Ъ Ь Ь Э Э Я а в г е ж х ш 332  О Щ Ъ Ь Э ж и с ш Ъ Ъ Ь Ь Э Э Я а в г е ж и с ш -х,ЃUаa Ѕj s6eEG?-<В.oD%ўA1—(:"AGK‡PP -Q@2VСgXy]b[b