Coverage description
An Insurance Services Office (ISO) standard form. It removes the Comprehensive Coverage deductible for repairing or replacing damaged safety glass on the covered autos designated in the schedule.
Editions
Edition dates as filed, newest first. Filing counts include every state submission that lists the edition.
| Edition | Filings | Companies | States | Filed |
|---|---|---|---|---|
| 11 20Nov 2020Latest | 268 | 128 | 45 | Nov 2021 to Sep 2026 |
Filed by one company only: 01 23 (Midwest Family Group, 20 filings).
1 other edition date appears in one or two filings each, often carrier-specific versions: 11/01/2020.
Where filings record what this form replaced, they name other forms CAD 09 26. Only some filings record replacements.
What the filings show
- Edition in use: in the past 12 months, 34 companies filed the 11 20 edition.
- The 01 23 edition appears only in filings from Midwest Family Group (20 filings in 20 states since Aug 4, 2022), which suggests a carrier-specific version.
- CA 20 54 (Employee Hired Autos) is filed alongside it most often, in 227 of the same filings (79%).
Filed under
Data from admitted P&C filings with state insurance departments, submitted Oct 2021 to Sep 2026, excluding withdrawn and rejected filings. One filing can cover several affiliated companies.
Carriers filing this form
The 10 carrier groups with the most filings that include CA 04 21, out of 60 in total.
| Carrier | Filings | States | Editions, most filed first | Last filed |
|---|---|---|---|---|
| Clear Blue Financial Group2 group companies filed it, led by Clear Blue Insurance Company and Rock Ridge Insurance Company | 42 | 35 | 11 20 | Jun 17, 2026 |
| OBS Holdings Group2 group companies filed it, led by Obsidian Insurance Company and Obsidian Pacific Insurance Company | 36 | 36 | 11 20 | Feb 3, 2023 |
| Donegal Group6 group companies filed it, led by Atlantic States Insurance Company and Donegal Mutual Insurance Company | 33 | 21 | 11 20 | Apr 27, 2026 |
| Midwest Family GroupMidwest Family Mutual Insurance Company | 20 | 20 | 01 23 | Sep 2, 2022 |
| Nationwide Corporation Group11 group companies filed it, led by Nationwide Agribusiness Insurance Company and Allied Insurance Company of America | 14 | 5 | 11 20 | Sep 22, 2025 |
| Arch Insurance Group3 group companies filed it, led by Arch Insurance Company and Arch Indemnity Insurance Company | 13 | 2 | 11 20 | Apr 8, 2026 |
| OLD Republic Group4 group companies filed it, led by BITCO General Insurance Corporation and BITCO National Insurance Company | 13 | 1 | 11 20 | May 11, 2026 |
| Scor GroupGeneral Security National Insurance Company | 10 | 1 | 11 20 | Jun 9, 2026 |
| Tokio Marine Holdings Incorporated Group2 group companies filed it, led by Safety National Casualty Corporation and Philadelphia Indemnity Insurance Company | 7 | 3 | 11 20 | Aug 27, 2026 |
| MS & AD Insurance Group3 group companies filed it, led by Mitsui Sumitomo Insurance Company of America and Mitsui Sumitomo Insurance USA Inc. | 6 | 4 | 11 20 | Aug 27, 2025 |
How the largest insurers handle CA 04 21
Groups among the largest commercial auto insurers that filed CA 04 21 or their own version in the past five years.
- Progressive GroupUses CA 04 21 in 1 filing
- Berkshire Hathaway GroupUses CA 04 21 in 1 filing
See more forms
Search related forms, compare editions, and research carrier filings with FilingFocus.
States
Number of filings that include CA 04 21 in each state, Oct 2021 to Sep 2026. Darker states have more filings.
Often filed with
Standard-style form numbers that appear in the same filings most often.
- CA 20 54Employee Hired Autos227 filings
- CA 20 01Lessor – Additional Insured and Loss Payee224 filings
- CA 20 71Auto Loan/Lease Gap Coverage219 filings
- CA 04 43Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation) – Automatic When Required by Written Contract or Agreement215 filings
- CA 23 17Truckers – Uniform Intermodal Interchange Endorsement Form Uiie – 1212 filings
- CA 04 22Earlier Notice of Cancellation Provided by Us211 filings
- CA 00 20Motor Carrier Coverage Form203 filings
- CA 04 49Primary and Noncontributory – Other Insurance Condition196 filings
- CA 04 44Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation)181 filings
- CA 23 05Wrong Delivery of Liquid Products179 filings
Recent filings
Latest filings that include this form number. Filed copies open in FilingFocus.
| Submitted | Company | State | Editions | Tracking number |
|---|---|---|---|---|
| Sep 10, 2026 | SECURA Insurance, A Mutual Companyand 1 more | IL | 11 20 | SEIC-135044227 |
| Sep 4, 2026 | Incline Casualty Company | SC | 11 20 | AIAD-135047572 |
| Aug 27, 2026 | Philadelphia Indemnity Insurance Company | NM | 11 20 | PHLX-135063316 |
| Jun 25, 2026 | Selective Insurance Company of Americaand 3 more | CO | 11 20 | SELC-134998854 |
| Jun 24, 2026 | Great American Alliance Insurance Companyand 3 more | CO | 11 20 | GACX-134993563 |
| Jun 19, 2026 | Addison Insurance Companyand 1 more | CO | 11 20 | UNFG-134905846 |
| Jun 18, 2026 | Sompo America Fire and Marine Insurance Companyand 1 more | CO | 11 20 | SMPJ-134972831 |
| Jun 17, 2026 | Clear Blue Insurance Company | MA | 11 20 | WESA-134946941 |
| Jun 9, 2026 | General Security National Insurance Company | CO | 11 20 | PERR-134978283 |
| Jun 9, 2026 | General Security National Insurance Company | CO | 11 20 | PERR-134978297 |
| May 21, 2026 | Jet Insurance Company | NM | 11 20 | MRTN-134878221 |
| May 11, 2026 | BITCO General Insurance Corporationand 1 more | CO | 11 20 | LDDX-134937509 |
Most filed ISO CA forms
- CA DS 03 Business Auto Declarations
- CA DS 21 Motor Carrier Declarations
- CA 00 01 Business Auto Coverage Form
- CA 28 03 Abuse Or Molestation Exclusion For Covered Autos Liability Exposure
- CA 23 17 Truckers - Uniform Intermodal Interchange Endorsement Form UIIE - 1
- CA 04 43 Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic When Required By Written Contract Or Agreement
- CA 04 44 Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation)
- CA 04 49 Primary and Noncontributory - Other Insurance Condition
- CA 20 01 Lessor - Additional Insured And Loss Payee
- CA 20 48 Designated Insured For Covered Autos Liability Coverage
- CA 00 20 Motor Carrier Coverage Form
- CA 20 71 Auto Loan/Lease Gap Coverage
See more carrier forms
Search forms by carrier, line of business, state, and wording with FilingFocus.