Coverage description
An Insurance Services Office (ISO) standard form. It states that the policy premium will be determined by a separate retrospective premium endorsement, identified by policy number, that forms part of the policy.
Editions
Edition dates as filed, newest first. Filing counts include every state submission that lists the edition.
| Edition | Filings | Companies | States | Filed |
|---|---|---|---|---|
| 04 84Apr 1984Latest | 187 | 98 | 17 | Nov 2021 to Oct 2026 |
What the filings show
- Edition in use: in the past 12 months, 27 companies filed the 04 84 edition.
- IL 09 23 (Retrospective Premium Endorsement - Exclusion of Retrospective Development Factors) is filed alongside it most often, in 187 of the same filings (100%).
Filed under
Commercial Auto Combinations 95Commercial General Liability 60Business Auto 7Other Liability 7Commercial Package 6Commercial Interline Filings 3
Data from admitted P&C filings with state insurance departments, submitted Oct 2021 to Oct 2026, excluding withdrawn and rejected filings.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 IL 09 21, out of 54 in total.
| Carrier | Filings | States | Editions, most filed first | Last filed |
|---|---|---|---|---|
| OLD Republic Group4 group companies filed it, led by BITCO General Insurance Corporation and BITCO National Insurance Company | 13 | 1 | 04 84 | May 11, 2026 |
| Markel Corporation Group4 group companies filed it, led by State National Insurance Company, Inc. and City National Insurance Company | 12 | 5 | 04 84 | Oct 22, 2026 |
| Tokio Marine Holdings Incorporated Group2 group companies filed it, led by Safety National Casualty Corporation and Philadelphia Indemnity Insurance Company | 12 | 3 | 04 84 | Aug 27, 2026 |
| Scor GroupGeneral Security National Insurance Company | 10 | 1 | 04 84 | Jun 9, 2026 |
| Sompo Group2 group companies filed it, led by Sompo America Insurance Company and Sompo America Fire and Marine Insurance Company | 10 | 1 | 04 84 | Jun 18, 2026 |
| Siriuspoint GroupSiriusPoint America Insurance Company | 9 | 3 | 04 84 | Jun 15, 2026 |
| Group 1001 Insurance Holdings GroupCLEAR SPRING PROPERTY AND CASUALTY COMPANY | 6 | 2 | 04 84 | Mar 18, 2026 |
| Nationwide Corporation Group7 group companies filed it, led by Allied Insurance Company of America and Nationwide Agribusiness Insurance Company | 6 | 3 | 04 84 | Feb 12, 2025 |
| WR Berkley Corporation Group2 group companies filed it, led by Intrepid Casualty Company and Berkley Casualty Company | 6 | 2 | 04 84 | Apr 18, 2023 |
| American International Group3 group companies filed it, led by Granite State Insurance Company and Illinois National Insurance Co. | 5 | 2 | 04 84 | Sep 15, 2023 |
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States
Number of filings that include IL 09 21 in each state, Oct 2021 to Oct 2026. Darker states have more filings.
Often filed with
Standard-style form numbers that appear in the same filings most often.
- IL 09 23Retrospective Premium Endorsement - Exclusion of Retrospective Development Factors187 filings
- IL 09 11Supplement to Retrospective Premium Endorsement (Final Premium Computation)180 filings
- IL 09 19Retrospective Premium Endorsement - Three Year Plan - Multiple Lines177 filings
- IL 09 18Retrospective Premium Endorsement - One Year Plan - Multiple Lines175 filings
- IL 09 20Retrospective Premium Endorsement - Long Term Construction Project - Multiple Lines174 filings
- IL 00 21Nuclear Energy Liability Exclusion Endorsement (Broad Form)163 filings
- IL 00 03Calculation of Premium158 filings
- IL 00 17Common Policy Conditions151 filings
- IL 12 01Policy Changes134 filings
- IL 09 17Resident Agent Countersignature Endorsement124 filings
Recent filings
Latest filings that include this form number. Filed copies open in FilingFocus.
| Submitted | Company | State | Editions | Tracking number |
|---|---|---|---|---|
| Oct 22, 2026 | State National Insurance Company, Inc. | CO | 04 84 | STNA-135128706 |
| Oct 6, 2026 | American Casualty Company of Reading, Pennsylvaniaand 5 more | CA | 04 84 | CNAB-135091690 |
| Aug 28, 2026 | Jet Insurance Company | SC | 04 84 | MRTN-134878222 |
| Aug 27, 2026 | Philadelphia Indemnity Insurance Company | NM | 04 84 | PHLX-135063316 |
| Jun 30, 2026 | Accredited Surety and Casualty Company, Inc. | CO | 04 84 | ACSA-135005169 |
| Jun 18, 2026 | Sompo America Fire and Marine Insurance Companyand 1 more | CO | 04 84 | SMPJ-134972831 |
| Jun 18, 2026 | Sompo America Insurance Company | CO | 04 84 | SMPJ-134985965 |
| Jun 17, 2026 | Atlantic Specialty Insurance Company | NM | 04 84 | BEAC-134983795 |
| Jun 17, 2026 | Atlantic Specialty Insurance Company | SC | 04 84 | BEAC-134983796 |
| Jun 17, 2026 | State Automobile Mutual Insurance Company | CO | 04 84 | STAT-134983865 |
| Jun 15, 2026 | SiriusPoint America Insurance Company | CO | 04 84 | MRTN-134978899 |
| Jun 15, 2026 | SiriusPoint America Insurance Company | CO | 04 84 | MRTN-134978902 |
Most filed ISO IL forms
- IL 00 17 Common Policy Conditions
- IL 12 01 Policy Changes
- IL 00 21 Nuclear Energy Liability Exclusion Endorsement (Broad Form)
- IL DS 00 Common Policy Declarations
- IL 09 85 Disclosure Pursuant to Terrorism Risk Insurance Act
- IL 00 03 Calculation of Premium
- IL 09 52 Cap On Losses From Certified Acts Of Terrorism
- IL 09 53 Exclusion of Certified Acts of Terrorism
- IL 09 98 Disclosure of Premium Through End of Year For Certified Acts of Terrorism Coverage (Pursuant to Terrorism Risk Insurance Act)
- IL 09 35 Exclusion of Certain Computer-Related Losses
- IL 09 99 Disclosure of Premium and Estimated Premium for Certified Acts of Terrorism Coverage (Pursuant to Terrorism Risk Insurance Act)
- IL 09 17 Resident Agent Countersignature Endorsement
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