<?xml version="1.0" encoding="UTF-8"?>
<?ACORD version="1.2.0"?>
<ACORD>
   <SignonRq>
      <SignonPswd>
         <CustId>
            <SPName>com.acuityfin</SPName>
            <CustPermId>ACUITY</CustPermId>
            <CustLoginId>ACU</CustLoginId>
         </CustId>
         <CustPswd>
            <EncryptionTypeCd>NONE</EncryptionTypeCd>
            <Pswd>aaabbbcccdddeefff</Pswd>
         </CustPswd>
      </SignonPswd>
      <ClientDt>2002-03-21</ClientDt>
      <CustLangPref>en-US</CustLangPref>
      <ClientApp>
         <Org>ACUITY</Org>
         <Name>iRate</Name>
         <Version>1</Version>
      </ClientApp>
   </SignonRq>
   <InsuranceSvcRq>
      <RqUID>W04899AEC607B432CA6D61826228EBF46W</RqUID>
      <PersAutoPolicyAddRq>
         <RqUID>WBA1ED78DFEB34AA2B0795298031CF985W</RqUID>
         <TransactionRequestDt>2002-03-21</TransactionRequestDt>
         <CurCd>USD</CurCd>
         <Producer>
            <GeneralPartyInfo>
               <NameInfo>
                  <PersonName>
                     <Surname>Eggebrecht</Surname>
                     <GivenName>Mike</GivenName>
                  </PersonName>
               </NameInfo>
            </GeneralPartyInfo>
            <ProducerInfo>
               <ContractNumber>0000</ContractNumber>
               <ProducerSubCode>ME</ProducerSubCode>
               <ResProducerLicenseNumber>WI1877694876</ResProducerLicenseNumber>
               <ResProducerLicenseExpirationDt>2003-05-18</ResProducerLicenseExpirationDt>
            </ProducerInfo>
         </Producer>
         <InsuredOrPrincipal>
            <ItemIdInfo>
               <AgencyId>0123</AgencyId>
            </ItemIdInfo>
            <GeneralPartyInfo>
               <NameInfo>
                  <PersonName>
                     <Surname>McDonough</Surname>
                     <GivenName>Brynn</GivenName>
                     <OtherGivenName></OtherGivenName>
                  </PersonName>
               </NameInfo>
               <Addr>
                  <Addr1>1652 Dogwood Lane</Addr1>
                  <City>Montello</City>
                  <StateProvCd></StateProvCd>
                  <PostalCode>54612</PostalCode>
               </Addr>
            </GeneralPartyInfo>
         </InsuredOrPrincipal>
         <PersPolicy>
           <LOBCd>AUTO</LOBCd>
            <NAICCd>14184</NAICCd>
            <ContractTerm>
               <EffectiveDt>2002-01-10</EffectiveDt>
               <ExpirationDt>2002-07-10</ExpirationDt>
            </ContractTerm>
            <BillingMethodCd>BA</BillingMethodCd>
            <OriginalInceptionDt>2002-10-11</OriginalInceptionDt>
            <PaymentOption>
               <PaymentPlanCd>10</PaymentPlanCd>
               <DepositAmt>
                  <Amt>0</Amt>
               </DepositAmt>
            </PaymentOption>
            <PersApplicationInfo>
               <InsuredOrPrincipal>
                 <GeneralPartyInfo>
                     <NameInfo>
                       <PersonName>
                           <Surname>McDonough</Surname>
                           <GivenName>Brynn</GivenName>
                           <OtherGivenName>S</OtherGivenName>
                        </PersonName>
                     </NameInfo>
                     <Addr>
                        <Addr1>1652 Dogwood Lane</Addr1>
                        <City>Montello</City>
                        <StateProvCd>WI</StateProvCd>
                        <PostalCode>54612</PostalCode>
                        <County>Pierce</County>
                     </Addr>
                  </GeneralPartyInfo>
                  <InsuredOrPrincipalInfo>
                     <InsuredOrPrincipalRoleCd>Insured</InsuredOrPrincipalRoleCd>
                  </InsuredOrPrincipalInfo>
               </InsuredOrPrincipal>
            </PersApplicationInfo>
            <DriverVeh DriverRef="WC6ABFC09F42A4C1A996331E9DAA5E8D7W" VehRef="W70544B32F83543D593E50C194218FE96W">
               <UsePct>100</UsePct>
            </DriverVeh>
            <DriverVeh DriverRef="W4B15D3DE968C4F99A111483D146A0333W" VehRef="W4E8F75820AEE4B2A9E14781A36AD5B1EW">
               <UsePct>100</UsePct>
            </DriverVeh>
            <DriverVeh DriverRef="WC6ABFC09F42A4C1A996331E9DAA5E8D71" VehRef="W70544B32F83543D593E50C194218FE961">
               <UsePct>100</UsePct>
            </DriverVeh>
            <DriverVeh DriverRef="W4B15D3DE968C4F99A111483D146A03332" VehRef="W4E8F75820AEE4B2A9E14781A36AD5B1E2">
               <UsePct>100</UsePct>
            </DriverVeh>
         </PersPolicy>
         <PersAutoLineBusiness id="WE3C98F5E56AA4D73A6955172CBFA7B83W">
            <LOBCd>AUTO</LOBCd>
            <PersDriver id="W4B15D3DE968C4F99A111483D146A0333W">
               <ItemIdInfo>
                  <InsurerId>1</InsurerId>
               </ItemIdInfo>
               <GeneralPartyInfo>
                 <NameInfo>
                     <PersonName>
                        <Surname>Brynn McDonough</Surname>
                        <GivenName></GivenName>
                     </PersonName>
                     <TaxIdentity>                        <TaxIdTypeCd>SSN</TaxIdTypeCd>
                        <TaxId>123-45-6789</TaxId>
                     </TaxIdentity>
                  </NameInfo>
               </GeneralPartyInfo>
               <DriverInfo>
                  <PersonInfo>
                     <GenderCd>F</GenderCd>
                     <BirthDt>1960-05-03</BirthDt>
                     <MaritalStatusCd>S</MaritalStatusCd>
                  </PersonInfo>
                  <DriversLicense>
                     <LicensedDt>1980-06-01</LicensedDt>
                     <DriversLicenseNumber>WI398776554</DriversLicenseNumber>
                     <StateProvCd></StateProvCd>
                  </DriversLicense>
                  <CreditScoreInfo>
                     <CreditScore>800</CreditScore>
                     <CreditScoreDt>2002-02-14</CreditScoreDt>
                  </CreditScoreInfo>
               </DriverInfo>
               <PersDriverInfo VehPrincipallyDrivenRef="W4E8F75820AEE4B2A9E14781A36AD5B1EW">
                  <DefensiveDriverDt></DefensiveDriverDt>
              </PersDriverInfo>
            </PersDriver>
            <PersDriver id="W4B15D3DE968C4F99A111483D146A0333W">
               <ItemIdInfo>
                  <InsurerId>2</InsurerId>
               </ItemIdInfo>
               <GeneralPartyInfo>
                 <NameInfo>
                     <PersonName>
                        <Surname>Mark McDonough</Surname>
                        <GivenName></GivenName>
                     </PersonName>
                     <TaxIdentity>                        <TaxIdTypeCd>SSN</TaxIdTypeCd>
                        <TaxId>987-65-4321</TaxId>
                     </TaxIdentity>
                  </NameInfo>
               </GeneralPartyInfo>
               <DriverInfo>
                  <PersonInfo>
                     <GenderCd>F</GenderCd>
                     <BirthDt>1962-12-12</BirthDt>
                     <MaritalStatusCd>S</MaritalStatusCd>
                  </PersonInfo>
                  <DriversLicense>
                     <LicensedDt>1980-01-05</LicensedDt>
                     <DriversLicenseNumber>WI8877234532</DriversLicenseNumber>
                     <StateProvCd></StateProvCd>
                  </DriversLicense>
                  <CreditScoreInfo>
                     <CreditScore>800</CreditScore>
                     <CreditScoreDt>2002-02-14</CreditScoreDt>
                  </CreditScoreInfo>
               </DriverInfo>
               <PersDriverInfo VehPrincipallyDrivenRef="W4E8F75820AEE4B2A9E14781A36AD5B1EW">
                  <DefensiveDriverDt></DefensiveDriverDt>
              </PersDriverInfo>
            </PersDriver>
            <PersVeh id="W70544B32F83543D593E50C194218FE96W" RatedDriverRef="WC6ABFC09F42A4C1A996331E9DAA5E8D7W" RegisteredOwnerRef="WC6ABFC09F42A4C1A996331E9DAA5E8D7W">
               <ItemIdInfo>
                  <InsurerId>1</InsurerId>
               </ItemIdInfo>
               <Manufacturer>Oldsmobile</Manufacturer>
               <Model>Bravada</Model>
               <ModelYear>2000</ModelYear>
               <VehBodyTypeCd>2D</VehBodyTypeCd>
               <CostNewAmt>
                  <Amt>35,000</Amt>
               </CostNewAmt>
		   <NewVehInd>N</NewVehInd>
               <NumDaysDrivenPerWeek>4</NumDaysDrivenPerWeek>
               <EstimatedAnnualDistance>
                  <NumUnits>150</NumUnits>
               </EstimatedAnnualDistance>
               <LeasedVehInd>0</LeasedVehInd>
               <LeasedDt>2000-01-01</LeasedDt>
               <PurchaseDt>2000-03-05</PurchaseDt>
               <RegistrationStateProvCd>WI</RegistrationStateProvCd>
               <TerritoryCd>012</TerritoryCd>
		   <VehIdentificationNumber>AT1HOEE902312000554</VehIdentificationNumber>
               <VehSymbolCd>011</VehSymbolCd>
               <CarpoolInd>Yes</CarpoolInd>
               <GaragingCd>A</GaragingCd>
               <DistanceOneWay>
                  <NumUnits>10</NumUnits>
               </DistanceOneWay>
               <MultiCarDiscountInd>Yes</MultiCarDiscountInd>
               <VehUseCd>BU</VehUseCd>
               <SeatBeltTypeCd>Active</SeatBeltTypeCd>
               <AirBagTypeCd>Driver</AirBagTypeCd>
               <AntiLockBrakeCd>2</AntiLockBrakeCd>
               <AntiTheftDeviceCd>A</AntiTheftDeviceCd>
               <OdometerReading>22,000</OdometerReading>
               <Govern></Govern>
               <VehPerformanceCd>BASIC</VehPerformanceCd>
               <ColorCd>120</ColorCd>
               <Coverage>
                  <CoverageCd>BI</CoverageCd>
                  <Limit>
                     <FormatInteger>50,000</FormatInteger>
                     <LimitAppliesToCd>PerPerson</LimitAppliesToCd>
                  </Limit>
                  <Limit>
                     <FormatInteger>10,000</FormatInteger>
                     <LimitAppliesToCd>PerAcc</LimitAppliesToCd>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>MEDPM</CoverageCd>
                  <Limit>
                     <FormatInteger>10,000</FormatInteger>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>PD</CoverageCd>
                  <Limit>
                     <FormatInteger>20,000</FormatInteger>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>UM</CoverageCd>
                  <Limit>
                     <FormatInteger>50,000</FormatInteger>
                     <LimitAppliesToCd>PerPerson</LimitAppliesToCd>
                  </Limit>
                  <Limit>
                     <FormatInteger>100,000</FormatInteger>
                     <LimitAppliesToCd>PerAcc</LimitAppliesToCd>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>UNDUM</CoverageCd>
                  <Limit>
                     <FormatInteger>50,000</FormatInteger>
                     <LimitAppliesToCd>PerPerson</LimitAppliesToCd>
                  </Limit>
                  <Limit>
                     <FormatInteger>100,000</FormatInteger>
                     <LimitAppliesToCd>PerAcc</LimitAppliesToCd>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>COLL</CoverageCd>
                  <Deductible>
                     <FormatInteger>120</FormatInteger>
                     <DeductibleTypeCd>FL</DeductibleTypeCd>
                  </Deductible>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>COMP</CoverageCd>
                  <Deductible>
                     <FormatInteger>250</FormatInteger>
                     <DeductibleTypeCd>FL</DeductibleTypeCd>
                  </Deductible>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
            </PersVeh>
            <PersVeh id="W70544B32F83543D593E50C194218FE96W" RatedDriverRef="WC6ABFC09F42A4C1A996331E9DAA5E8D7W" RegisteredOwnerRef="WC6ABFC09F42A4C1A996331E9DAA5E8D7W">
               <ItemIdInfo>
                  <InsurerId>2</InsurerId>
               </ItemIdInfo>
               <Manufacturer>Ford</Manufacturer>
               <Model>Econoline</Model>
               <ModelYear>1986</ModelYear>
               <VehBodyTypeCd>2D</VehBodyTypeCd>
               <CostNewAmt>
                  <Amt>15,000</Amt>
               </CostNewAmt>
		   <NewVehInd>U</NewVehInd>
               <NumDaysDrivenPerWeek>4</NumDaysDrivenPerWeek>
               <EstimatedAnnualDistance>
                  <NumUnits>250</NumUnits>
               </EstimatedAnnualDistance>
               <LeasedVehInd>0</LeasedVehInd>
               <LeasedDt>2000-02-02</LeasedDt>
               <PurchaseDt>2000-06-05</PurchaseDt>
               <RegistrationStateProvCd>WI</RegistrationStateProvCd>
               <TerritoryCd>012</TerritoryCd>
		   <VehIdentificationNumber>JT1HOEE9000025484</VehIdentificationNumber>
               <VehSymbolCd>011</VehSymbolCd>
               <CarpoolInd>Yes</CarpoolInd>
               <GaragingCd>A</GaragingCd>
               <DistanceOneWay>
                  <NumUnits>10</NumUnits>
               </DistanceOneWay>
               <MultiCarDiscountInd>Yes</MultiCarDiscountInd>
               <VehUseCd>BU</VehUseCd>
               <SeatBeltTypeCd>Active</SeatBeltTypeCd>
               <AirBagTypeCd>Driver</AirBagTypeCd>
               <AntiLockBrakeCd>2</AntiLockBrakeCd>
               <AntiTheftDeviceCd>A</AntiTheftDeviceCd>
               <OdometerReading>14,870</OdometerReading>
               <Govern></Govern>
               <VehPerformanceCd>BASIC</VehPerformanceCd>
               <ColorCd>120</ColorCd>
               <Coverage>
                  <CoverageCd>BI</CoverageCd>
                  <Limit>
                     <FormatInteger>50,000</FormatInteger>
                     <LimitAppliesToCd>PerPerson</LimitAppliesToCd>
                  </Limit>
                  <Limit>
                     <FormatInteger>10,000</FormatInteger>
                     <LimitAppliesToCd>PerAcc</LimitAppliesToCd>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>MEDPM</CoverageCd>
                  <Limit>
                     <FormatInteger>10,000</FormatInteger>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>PD</CoverageCd>
                  <Limit>
                     <FormatInteger>20,000</FormatInteger>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>UM</CoverageCd>
                  <Limit>
                     <FormatInteger>50,000</FormatInteger>
                     <LimitAppliesToCd>PerPerson</LimitAppliesToCd>
                  </Limit>
                  <Limit>
                     <FormatInteger>100,000</FormatInteger>
                     <LimitAppliesToCd>PerAcc</LimitAppliesToCd>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>UNDUM</CoverageCd>
                  <Limit>
                     <FormatInteger>50,000</FormatInteger>
                     <LimitAppliesToCd>PerPerson</LimitAppliesToCd>
                  </Limit>
                  <Limit>
                     <FormatInteger>100,000</FormatInteger>
                     <LimitAppliesToCd>PerAcc</LimitAppliesToCd>
                  </Limit>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>COLL</CoverageCd>
                  <Deductible>
                     <FormatInteger>120</FormatInteger>
                     <DeductibleTypeCd>FL</DeductibleTypeCd>
                  </Deductible>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
               <Coverage>
                  <CoverageCd>COMP</CoverageCd>
                  <Deductible>
                     <FormatInteger>250</FormatInteger>
                     <DeductibleTypeCd>FL</DeductibleTypeCd>
                  </Deductible>
                  <EffectiveDt>2002-01-10</EffectiveDt>
                  <ExpirationDt>2002-07-10</ExpirationDt>
               </Coverage>
            </PersVeh>
            <QuestionAnswer>               <QuestionCd>AUTOB10</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUTOP01</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUTOP02</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUTOP03</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>GENRL22</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUTOP04</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUTOP05</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUTOP06</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUTOP07</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>GENRL26</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>GENRL21</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUTOP08</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>           <QuestionAnswer>               <QuestionCd>AUTOB12</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>            <QuestionAnswer>               <QuestionCd>AUPFL01</QuestionCd>               <YesNoCd>NO</YesNoCd>            </QuestionAnswer>         </PersAutoLineBusiness>
      </PersAutoPolicyAddRq>
   </InsuranceSvcRq>
</ACORD>

