Form G-178 - The Chief Operating Officer Of An Insurer Making Property & Casualty Filings With The Arizona Department Of Insurance - State Of Arizona Department Of Insurance

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STATE OF ARIZONA
DEPARTMENT OF INSURANCE
RATES AND REGULATIONS DIVISION
JANE DEE HULL
2910 NORTH 44th STREET, SUITE 210
CHARLES R. COHEN
Governor
PHOENIX, ARIZONA 85018-7256
Director of Insurance
TO:
THE CHIEF OPERATING OFFICER OF AN INSURER MAKING PROPERTY &
CASUALTY FILINGS WITH THE ARIZONA DEPARTMENT OF INSURANCE
In the past, the Arizona Department of Insurance received filings from individuals who were not
authorized by the insurer to make filings on its behalf. Therefore, to prevent future problems all
insurers should list below, on this form G-178, the names of those persons authorized to file forms
and rates/rules on behalf of the insurer or insurers. The Rates & Regulations Division will retain the
G-178 on file until the insurer desires to amend the form, at which time the insurer should file a new
G-178.
NAME OF INSURER
NAIC #
NAME OF AUTHORIZED
TITLE
TELEPHONE #
FILER
Typed Name Of Company Officer
Title
Signature
G-178 (ED. 11/98)

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