Attachment C Sample Company Vehicle Loss History Report.pdf

AMAIT Fleet Loss Run | Policy Year:

Policy Number

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

2016Policy Effective Year Claim Number

2699726

Claim Status

Closed

Date of Loss

07/04/2016

Claim Changes

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

FAILURE TO YIELD - THE INSURED VEHICLE FAILED TO YIELD WITH

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $35.33$0.00 $0.00 $0.00 $0.00

Liability - Bodily Injury $0.00 $2,218.25$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $0.00$2,483.19 $0.00 $0.00 $2,483.19

Claim Total $2,483.19$0.00 $2,253.58$2,483.19 $0.00 $0.00

Liability Subtotal $0.00 $2,483.19 $2,218.25 $0.00 $2,483.19$0.00

Claim Number

2701086

Claim Status

Closed

Date of Loss

07/06/2016

Claim Changes

Reserve

Loss Reporting Location Code

405-ARKANSAS STATE BANK DEPARTMENT

Net Expense Paid

RECORD ONLY CLAIMANT BACKED INTO OUR VEHICLE IN THE PARKING

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Page 1 of 998Monday, March 3, 2025

Attachment C

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2834503

Claim Status

Closed

Date of Loss

07/08/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

261-TOBACCO CONTROL BOARD

Net Expense Paid

WEATHER- COMP - HAIL DAMAGE TO THE INSURED VEHICLE.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2706902

Claim Status

Closed

Date of Loss

07/12/2016

Claim Changes

Reserve

Loss Reporting Location Code

425-ARKANSAS INSURANCE DEPARTMENT

Net Expense Paid

REARENDED - IV REARENDED OV. NO INJURIES - MINOR DAMAGE TO

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $23.43$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$1,154.45 $0.00 $0.00 $1,154.45

Claim Total $1,154.45$0.00 $46.86$1,154.45 $0.00 $0.00

Liability Subtotal $0.00 $1,154.45 $23.43 $0.00 $1,154.45$0.00

Page 2 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2710229

Claim Status

Closed

Date of Loss

07/13/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

REARENDED - ANTWAIN ROBINSON AND TWO PASSENGERS INJURED IN

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2709949

Claim Status

Closed

Date of Loss

07/16/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

VANDALISM - THE INSURED'S PARKED VEHICLE WAS VANDALIZED. PRY

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Comp $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Page 3 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2711471

Claim Status

Closed

Date of Loss

07/18/2016

Claim Changes

Reserve

Loss Reporting Location Code

582-RIVERSIDE VO-TECH SCHOOL

Net Expense Paid

BACKING - THE INSURED BACKED INTO THE CLAIMANT PARKED

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Bodily Injury $0.00 $0.00$1,000.00 $0.00 $0.00 $1,000.00

Liability - Property Damage $0.00 $23.43$675.27 $0.00 $0.00 $675.27

Claim Total $1,675.27$0.00 $23.43$1,675.27 $0.00 $0.00

Liability Subtotal $0.00 $1,675.27 $23.43 $0.00 $1,675.27$0.00

Claim Number

2711451

Claim Status

Closed

Date of Loss

07/20/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

NOT AT FAULT, OTHER DRIVER (CIRCUIT JUDGE) FAILED TO YIELD

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 4 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2714964

Claim Status

Closed

Date of Loss

07/25/2016

Claim Changes

Reserve

Loss Reporting Location Code

165-UNIVERSITY OF CENTRAL ARKANSAS

Net Expense Paid

BACKING - THE INSURED BACKED INTO THE CLAIMANT'S PARKED

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$2,809.45 $0.00 $0.00 $2,809.45

Claim Total $2,809.45$0.00 $23.43$2,809.45 $0.00 $0.00

Liability Subtotal $0.00 $2,809.45 $23.43 $0.00 $2,809.45$0.00

Claim Number

2715356

Claim Status

Closed

Date of Loss

07/26/2016

Claim Changes

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

REARENDED - THE INSURED REARENDED THE CLAIMANT VEHICLE.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $23.43$2,584.00 $0.00 $0.00 $2,584.00

Claim Total $2,584.00$0.00 $23.43$2,584.00 $0.00 $0.00

Liability Subtotal $0.00 $2,584.00 $23.43 $0.00 $2,584.00$0.00

Page 5 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2717048

Claim Status

Closed

Date of Loss

07/27/2016

Claim Changes

Reserve

Loss Reporting Location Code

063-OFFICE OF SECRETARY OF STATE

Net Expense Paid

NOT AT FAULT - THE CLAIMANT CAME THROUGH A RED LIGHT AND

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $549.43$7,050.39 $0.00 $0.00 $7,050.39

Claim Total $7,050.39$0.00 $549.43$7,050.39 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2717060

Claim Status

Closed

Date of Loss

07/27/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

630-DFA-REVENUE DIVISION

Net Expense Paid

NOT AT FAULT - REARENDED - IV WAS STOPPED AT RED LIGHT AND

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 6 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2725541

Claim Status

Closed

Date of Loss

07/27/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

STRUCK OBJECT - THE INSURED VEHICLE STRUCK A CONCRETE BASE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $23.43$812.45 $0.00 $0.00 $812.45

Claim Total $812.45$0.00 $23.43$812.45 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2730464

Claim Status

Closed

Date of Loss

07/28/2016

Claim Changes

Reserve

Loss Reporting Location Code

610-DIVISION OF FINANCE & BUDGET (MANAGE

Net Expense Paid

BACKING - IV BACKED INTO A PARKED UNOCCUPIED VEHICLE NO

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $23.43$1,177.53 $0.00 $0.00 $1,177.53

Claim Total $1,177.53$0.00 $23.43$1,177.53 $0.00 $0.00

Liability Subtotal $0.00 $1,177.53 $23.43 $0.00 $1,177.53$0.00

Page 7 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2720043

Claim Status

Closed

Date of Loss

07/30/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

NOT AT FAULT - BACKING - OV BACKED OUT OF HIS DRIVEWAY INTO

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2720242

Claim Status

Closed

Date of Loss

08/02/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

NOT AT FAULT - INSURED WAS HIT BEHIND THE REAR PASSENGER

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $70.38$3,771.76 ($88.78) $0.00 $3,682.98

Liability - Uninsured Motorists $0.00 $0.00$3,000.00 $0.00 $0.00 $3,000.00

Claim Total $6,682.98$0.00 $70.38$6,771.76 ($88.78) $0.00

Liability Subtotal $0.00 $3,000.00 $0.00 $0.00 $3,000.00$0.00

Page 8 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2721859

Claim Status

Closed

Date of Loss

08/02/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

REARENDED-INSURED DRIVER WAS TRYING TO GET IN THE RIGHT LANE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2721863

Claim Status

Closed

Date of Loss

08/04/2016

Claim Changes

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

REARENDED WE WERE AT THE INTERSECTION OF MAIN AND ARKANSAS

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $23.43$5,952.84 $0.00 $0.00 $5,952.84

Claim Total $5,952.84$0.00 $23.43$5,952.84 $0.00 $0.00

Liability Subtotal $0.00 $5,952.84 $23.43 $0.00 $5,952.84$0.00

Page 9 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2722716

Claim Status

Closed

Date of Loss

08/04/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

400-445-DEPARTMENT OF AGRICULTURE PLANT

Net Expense Paid

RECORD ONLY MICHELLE COOPER CALLED IN THAT LAST NIGHT A

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2725587

Claim Status

Closed

Date of Loss

08/10/2016

Claim Changes

Reserve

Loss Reporting Location Code

425-ARKANSAS INSURANCE DEPARTMENT

Net Expense Paid

NOT AT FAULT - CLAIMANT VEHICLE 1 LOST CONTROL AND STRUCK

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 10 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2725882

Claim Status

Closed

Date of Loss

08/11/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

NOT AT FAULT INSURED VEHICLE WAS REARENDED.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2728192

Claim Status

Closed

Date of Loss

08/12/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

080-ARKANSAS GAME AND FISH COMMISSION

Net Expense Paid

NOT AT FAULT - THE CLAIMANT REARENDED THE INSURED VEHICLE.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 11 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2729561

Claim Status

Closed

Date of Loss

08/12/2016

Claim Changes

Reserve

Loss Reporting Location Code

125A-ARKANSAS STATE UNIVERSITY-JONESBORO

Net Expense Paid

BACKING - THE INSURED STRUCK THE CLAIMANT PARKED VEHICLE

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $714.25$962.89 $0.00 $0.00 $962.89

Claim Total $962.89$0.00 $714.25$962.89 $0.00 $0.00

Liability Subtotal $0.00 $962.89 $714.25 $0.00 $962.89$0.00

Claim Number

2728475

Claim Status

Closed

Date of Loss

08/14/2016

Claim Changes

Reserve

Loss Reporting Location Code

975-MILITARY DEPARTMENT

Net Expense Paid

SIDESWIPED - THE INSURED STRUCK THE CLAIMANT'S PARKED

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$2,517.29 $0.00 $0.00 $2,517.29

Claim Total $2,517.29$0.00 $23.43$2,517.29 $0.00 $0.00

Liability Subtotal $0.00 $2,517.29 $23.43 $0.00 $2,517.29$0.00

Page 12 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2729535

Claim Status

Closed

Date of Loss

08/14/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

IV REAR-ENDED CV, SWERVED INTO RIGHT LANE AND STRUCK ANOTHER

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $35.19$8,457.67 $0.00 $0.00 $8,457.67

Liability - Bodily Injury $0.00 $12,171.14$67,500.00 $0.00 $0.00 $67,500.00

Liability - Property Damage $0.00 $58.62$9,951.79 $0.00 $0.00 $9,951.79

Claim Total $85,909.46$0.00 $12,264.95$85,909.46 $0.00 $0.00

Liability Subtotal $0.00 $77,451.79 $12,229.76 $0.00 $77,451.79$0.00

Claim Number

2860858

Claim Status

Closed

Date of Loss

08/14/2016

Claim Changes

Reserve

Loss Reporting Location Code

975-MILITARY DEPARTMENT

Net Expense Paid

SIDESWIPED - INSURED DRIVER COLLIDED WITH A PRIVATE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 13 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2728515

Claim Status

Closed

Date of Loss

08/15/2016

Claim Changes

Reserve

Loss Reporting Location Code

165-UNIVERSITY OF CENTRAL ARKANSAS

Net Expense Paid

BACKING CLAIMANT STATED HE WAS BACKING OUT OF PARKING LOT,

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$2,840.57 $0.00 $0.00 $2,840.57

Claim Total $2,840.57$0.00 $23.43$2,840.57 $0.00 $0.00

Liability Subtotal $0.00 $2,840.57 $23.43 $0.00 $2,840.57$0.00

Claim Number

2729522

Claim Status

Closed

Date of Loss

08/15/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

BACKING - IV WAS BACKING UP TO DOCK AND DID NOT SEE OTHER

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $23.43$1,683.22 $0.00 $0.00 $1,683.22

Claim Total $1,683.22$0.00 $23.43$1,683.22 $0.00 $0.00

Page 14 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2729707

Claim Status

Closed

Date of Loss

08/16/2016

Claim Changes

Reserve

Loss Reporting Location Code

645-DEPARTMENT OF HEALTH

Net Expense Paid

NOT AT FAULT - THE CLAIMANT VEHICLE STRUCK THE INSURED

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2730241

Claim Status

Closed

Date of Loss

08/16/2016

Claim Changes

Reserve

Loss Reporting Location Code

115A SOUTHERN ARKANSAS UNIVERSITY-TECHNI

Net Expense Paid

BACKING - THE INSURED BACKED INTO THE CLAIMANT'S PARKED

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $551.25$5,080.57 $0.00 $0.00 $5,080.57

Claim Total $5,080.57$0.00 $551.25$5,080.57 $0.00 $0.00

Liability Subtotal $0.00 $5,080.57 $551.25 $0.00 $5,080.57$0.00

Page 15 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2732671

Claim Status

Closed

Date of Loss

08/18/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

900-DIVISION OF PARKS AND TOURISM

Net Expense Paid

NOT AT FAULT - IV SIGNALED TO MAKE A LEFT HAND TURN ONTO HWY

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2736032

Claim Status

Closed

Date of Loss

08/19/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

VANDALISM - OFFENDER/INMATE VANDALIZED TWO STATE VEHICLES

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 16 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2732999

Claim Status

Closed

Date of Loss

08/20/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

NOT AT FAULT - THE CLAIMANT SEMI-TRUCK CHANGED LANES AND

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $29.82$5,098.24 ($558.61) ($4,539.63) $0.00

Liability - Medical Payments $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $29.82$5,098.24 ($558.61) ($4,539.63)

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2735795

Claim Status

Closed

Date of Loss

08/22/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

NOT AT FAULT_BACKING - CLAIMANT BACKED INTO STATE VEHICLE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 17 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2739039

Claim Status

Closed

Date of Loss

08/22/2016

Claim Changes

Reserve

Loss Reporting Location Code

410-ARKANSAS SECURITIES DEPARTMENT

Net Expense Paid

NOT AT FAULT - THE INSURED'S PARKED/UNOCCUPIED VEHICLE WAS

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $23.43$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $23.43$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2734913

Claim Status

Closed

Date of Loss

08/23/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

REARENDED INSURED DRIVER REAR ENDED CLAIMANT VEHICLE WHEN IT

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $29.82$6,188.52 ($508.61) $0.00 $5,679.91

Liability - Property Damage $0.00 $0.00$3,091.84 $0.00 $0.00 $3,091.84

Claim Total $8,771.75$0.00 $29.82$9,280.36 ($508.61) $0.00

Liability Subtotal $0.00 $3,091.84 $0.00 $0.00 $3,091.84$0.00

Page 18 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2735057

Claim Status

Closed

Date of Loss

08/23/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

165-UNIVERSITY OF CENTRAL ARKANSAS

Net Expense Paid

NOT AT FAULT - THE INSURED'S VEHICLE WAS REARENDED BY THE

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2736579

Claim Status

Closed

Date of Loss

08/24/2016

Claim Changes

Reserve

Loss Reporting Location Code

165-UNIVERSITY OF CENTRAL ARKANSAS

Net Expense Paid

THE INSURED'S MOWER SLIPPED OFF THE CURB AND STRUCK THE

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 19 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2736516

Claim Status

Closed

Date of Loss

08/26/2016

Claim Changes

Reserve

Loss Reporting Location Code

261-TOBACCO CONTROL BOARD

Net Expense Paid

NOT AT FAULT - OTHER VEHICLE REAR ENDED INSURED VEHICLE.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2749113

Claim Status

Closed

Date of Loss

08/30/2016

Claim Changes

Reserve

Loss Reporting Location Code

125A-ARKANSAS STATE UNIVERSITY-JONESBORO

Net Expense Paid

NOT AT FAULT - INSURED WAS CROSSING THE PARKING LOT IN A

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $1,004.25$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $1,004.25$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $1,004.25 $0.00 $0.00$0.00

Page 20 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2744306

Claim Status

Closed

Date of Loss

09/02/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

FOR RECORD ONLY - NOT AT FAULT - IV WAS PARKED AND

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2747477

Claim Status

Closed

Date of Loss

09/06/2016

Claim Changes

Reserve

Loss Reporting Location Code

900-DIVISION OF PARKS AND TOURISM

Net Expense Paid

BACKING - IV WAS BACKING OUT OF PARKING SPACE AND GRAZED OV

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $70.00$1,559.01 $0.00 $0.00 $1,559.01

Claim Total $1,559.01$0.00 $70.00$1,559.01 $0.00 $0.00

Liability Subtotal $0.00 $1,559.01 $70.00 $0.00 $1,559.01$0.00

Page 21 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2748508

Claim Status

Closed

Date of Loss

09/06/2016

Claim Changes

Reserve

Loss Reporting Location Code

480-DIVISION OF CORRECTION

Net Expense Paid

NOT AT FAULT - OV REARENDED IV AND LEFT THE SCENE ONE OF THE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Uninsured Motorists $0.00 $0.00$12,000.00 $0.00 $0.00 $12,000.00

Claim Total $12,000.00$0.00 $0.00$12,000.00 $0.00 $0.00

Liability Subtotal $0.00 $12,000.00 $0.00 $0.00 $12,000.00$0.00

Claim Number

2744876

Claim Status

Closed

Date of Loss

09/07/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

BACKING - IV AND OV BACKING OUT OF PARKING SPACES AT THE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $23.43$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $23.43$0.00 $0.00 $0.00

Page 22 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2745641

Claim Status

Closed

Date of Loss

09/07/2016

Claim Changes

Reserve

Loss Reporting Location Code

080-ARKANSAS GAME AND FISH COMMISSION

Net Expense Paid

BAKCING - INSURED VEHICLE BACKED INTO OTHER VEHICLE WHILE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $23.43$1,678.20 $0.00 $0.00 $1,678.20

Claim Total $1,678.20$0.00 $23.43$1,678.20 $0.00 $0.00

Liability Subtotal $0.00 $1,678.20 $23.43 $0.00 $1,678.20$0.00

Claim Number

2747759

Claim Status

Closed

Date of Loss

09/08/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

STRUCK OBJECT - THE INSURED VEHICLE LOST CONTROL ON WET

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $29.82$5,270.93 $0.00 $0.00 $5,270.93

Claim Total $5,270.93$0.00 $29.82$5,270.93 $0.00 $0.00

Page 23 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2748505

Claim Status

Closed

Date of Loss

09/14/2016

Claim Changes

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

CROSSED CENTER LINE - IV STRUCK OV NO INJURIES

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $475.00$6,800.00 $0.00 $0.00 $6,800.00

Claim Total $6,800.00$0.00 $475.00$6,800.00 $0.00 $0.00

Liability Subtotal $0.00 $6,800.00 $475.00 $0.00 $6,800.00$0.00

Claim Number

2748867

Claim Status

Closed

Date of Loss

09/14/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

630-DFA-REVENUE DIVISION

Net Expense Paid

NOT AT FAULT - OV REARENDED IV.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 24 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2749638

Claim Status

Closed

Date of Loss

09/15/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

NOT AT FAULT - GLASS - IV WAS TRAVELING NORTH ON HIGHWAY 325

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2751063

Claim Status

Closed

Date of Loss

09/15/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

INSURED DRIVER WALKED OUTSIDE TO FIND INSURED VEHICLE WITH A

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 25 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2751051

Claim Status

Closed

Date of Loss

09/16/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

INSURED BACKING HIT ANOTHER INSURED CAR ON PARKING LOT.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2751054

Claim Status

Closed

Date of Loss

09/16/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

NOT AT FAULT - UNKNOWN VEHICLE HIT AND DENTED THE IV WHILE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 26 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2751397

Claim Status

Closed

Date of Loss

09/16/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

OTHER - THE INSURED DRIVER OPENED THEIR DOOR AND STRUCK THE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$643.97 $0.00 $0.00 $643.97

Claim Total $643.97$0.00 $23.43$643.97 $0.00 $0.00

Liability Subtotal $0.00 $643.97 $23.43 $0.00 $643.97$0.00

Claim Number

2752113

Claim Status

Closed

Date of Loss

09/20/2016

Claim Changes

Reserve

Loss Reporting Location Code

400-415-DEPARTMENT OF AGRICULTURE FOREST

Net Expense Paid

REARENDED - IV REARENDED OV NO INJURIES

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$1,637.58 $0.00 $0.00 $1,637.58

Claim Total $1,637.58$0.00 $23.43$1,637.58 $0.00 $0.00

Liability Subtotal $0.00 $1,637.58 $23.43 $0.00 $1,637.58$0.00

Page 27 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2752663

Claim Status

Closed

Date of Loss

09/21/2016

Claim Changes

Reserve

Loss Reporting Location Code

053-OFFICE OF ATTORNEY GENERAL

Net Expense Paid

REARENDED - INSURED VEHICLE REAR-ENDED OTHER VEHICLE.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $23.43$5,209.65 $0.00 $0.00 $5,209.65

Liability - Bodily Injury $0.00 $0.00$3,350.00 $0.00 $0.00 $3,350.00

Liability - Property Damage $0.00 $53.25$9,796.62 $0.00 $0.00 $9,796.62

Claim Total $18,356.27$0.00 $76.68$18,356.27 $0.00 $0.00

Liability Subtotal $0.00 $13,146.62 $53.25 $0.00 $13,146.62$0.00

Claim Number

2755280

Claim Status

Closed

Date of Loss

09/24/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

NOT AT FAULT - SOMEONE SHOT UP INSURED VEHICLE DURING THE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 28 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2755554

Claim Status

Closed

Date of Loss

09/24/2016

Claim Changes

Reserve

Loss Reporting Location Code

480-DIVISION OF CORRECTION

Net Expense Paid

BACKING - IV BACKED INTO OV IN PARKING LOT AT WRIGHTSVILLE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $23.43$1,963.93 $0.00 $0.00 $1,963.93

Claim Total $1,963.93$0.00 $23.43$1,963.93 $0.00 $0.00

Liability Subtotal $0.00 $1,963.93 $23.43 $0.00 $1,963.93$0.00

Claim Number

2760940

Claim Status

Closed

Date of Loss

10/04/2016

Claim Changes

Reserve

Loss Reporting Location Code

063-OFFICE OF SECRETARY OF STATE

Net Expense Paid

SIDESWIPED - IV SIDESWIPED A PARKED AND UNOCCUPIED VEHICLE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$1,667.29 $0.00 $0.00 $1,667.29

Claim Total $1,667.29$0.00 $23.43$1,667.29 $0.00 $0.00

Liability Subtotal $0.00 $1,667.29 $23.43 $0.00 $1,667.29$0.00

Page 29 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2762547

Claim Status

Closed

Date of Loss

10/04/2016

Claim Changes

Reserve

Loss Reporting Location Code

519-ARKANSAS STATE LIBRARY

Net Expense Paid

NOT AT FAULT - IV WAS PARKED AND UNOCCUPIED AND UNKNOWN

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2762728

Claim Status

Closed

Date of Loss

10/05/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

STRUCK OBJECT - A SEMI-TRUCK'S TIRE BLEW WHILE TRAVELING IN

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 30 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2763264

Claim Status

Closed

Date of Loss

10/06/2016

Claim Changes

Reserve

Loss Reporting Location Code

480-DIVISION OF CORRECTION

Net Expense Paid

BACKING - IV WAS BACKING OUT OF PARKING SPACE, NEXT TO OV;

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $293.69$4,764.84 $0.00 $0.00 $4,764.84

Claim Total $4,764.84$0.00 $293.69$4,764.84 $0.00 $0.00

Liability Subtotal $0.00 $4,764.84 $293.69 $0.00 $4,764.84$0.00

Claim Number

2762734

Claim Status

Closed

Date of Loss

10/07/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

080-ARKANSAS GAME AND FISH COMMISSION

Net Expense Paid

NOT AT FAULT - OV RAN STOP SIGN AND HIT IV. BOTH VEHICLES

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 31 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2763257

Claim Status

Closed

Date of Loss

10/07/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

BACKING -IV BACKED INTO PARKED AND UNOCCUPIED VEHICLE NO

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$801.88 $0.00 $0.00 $801.88

Claim Total $801.88$0.00 $23.43$801.88 $0.00 $0.00

Liability Subtotal $0.00 $801.88 $23.43 $0.00 $801.88$0.00

Claim Number

2764351

Claim Status

Closed

Date of Loss

10/10/2016

Claim Changes

Reserve

Loss Reporting Location Code

053-OFFICE OF ATTORNEY GENERAL

Net Expense Paid

NOT AT FAULT - OV SWERVED INTO IV, STRIKING THE FRONT PANEL

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 32 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2765482

Claim Status

Closed

Date of Loss

10/10/2016

Claim Changes

Reserve

Loss Reporting Location Code

513-ARKANSAS SCHOOL FOR THE DEAF

Net Expense Paid

NOT AT FAULT - THE INSURED WAS STOPPED IN TRAFFIC AND

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $71.84$14,833.28 ($3,139.95) ($10,939.95) $753.38

Liability - Medical Payments $0.00 $0.00$5,000.00 $0.00 $0.00 $5,000.00

Liability - Underinsured Motor $0.00 $0.00$40,000.00 $0.00 $0.00 $40,000.00

Claim Total $45,753.38$0.00 $71.84$59,833.28 ($3,139.95) ($10,939.95)

Liability Subtotal $0.00 $45,000.00 $0.00 $0.00 $45,000.00$0.00

Claim Number

2767233

Claim Status

Closed

Date of Loss

10/12/2016

Claim Changes

Reserve

Loss Reporting Location Code

480-DIVISION OF CORRECTION

Net Expense Paid

THE INSURED STRUCK THE CLAIMANT'S PARKED/UNOCCUPIED VEHICLE.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $23.43$941.06 $0.00 $0.00 $941.06

Claim Total $941.06$0.00 $23.43$941.06 $0.00 $0.00

Liability Subtotal $0.00 $941.06 $23.43 $0.00 $941.06$0.00

Page 33 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2775013

Claim Status

Closed

Date of Loss

10/14/2016

Claim Changes

Reserve

Loss Reporting Location Code

790-ARKANSAS ECONOMIC DEVELOPMENT COMMIS

Net Expense Paid

ANIMAL - IV HIT DEER

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Comp $0.00 $23.43$4,229.37 $0.00 $0.00 $4,229.37

Claim Total $4,229.37$0.00 $23.43$4,229.37 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2769638

Claim Status

Closed

Date of Loss

10/17/2016

Claim Changes

Reserve

Loss Reporting Location Code

080-ARKANSAS GAME AND FISH COMMISSION

Net Expense Paid

LOST LOAD - SNAKE CARRIER CAME OUT OF BACK OF TRUCK AND HIT

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $23.43$1,540.93 $0.00 $0.00 $1,540.93

Claim Total $1,540.93$0.00 $23.43$1,540.93 $0.00 $0.00

Liability Subtotal $0.00 $1,540.93 $23.43 $0.00 $1,540.93$0.00

Page 34 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2770403

Claim Status

Closed

Date of Loss

10/17/2016

Claim Changes

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

BACKING - INSURED DRIVER WAS TRYING TO BACK OUT OF THE JAIL

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2772168

Claim Status

Closed

Date of Loss

10/19/2016

Claim Changes

Reserve

Loss Reporting Location Code

128-ARKANSAS STATE UNIVERSITY-MOUNTAIN H

Net Expense Paid

NOT AT FAULT - THE CLAIMANT RAN A STOP SIGN AND WAS STRUCK

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $140.44$6,917.58 $0.00 ($6,917.58) $0.00

Claim Total $0.00$0.00 $140.44$6,917.58 $0.00 ($6,917.58)

Page 35 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2774809

Claim Status

Closed

Date of Loss

10/20/2016

Claim Changes

Reserve

Loss Reporting Location Code

165-UNIVERSITY OF CENTRAL ARKANSAS

Net Expense Paid

BACKING - THE INSURED SHUTTLE BUS BACKED INTO ANOTHER

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $23.43$1,521.61 $0.00 $0.00 $1,521.61

Claim Total $1,521.61$0.00 $23.43$1,521.61 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2773655

Claim Status

Closed

Date of Loss

10/22/2016

Claim Changes

Reserve

Loss Reporting Location Code

080-ARKANSAS GAME AND FISH COMMISSION

Net Expense Paid

REARENDED - THE INSURED REARENDED THE CLAIMANT VEHICLE AT A

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $23.43$5,228.05 $0.00 $0.00 $5,228.05

Claim Total $5,228.05$0.00 $23.43$5,228.05 $0.00 $0.00

Liability Subtotal $0.00 $5,228.05 $23.43 $0.00 $5,228.05$0.00

Page 36 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2777202

Claim Status

Closed

Date of Loss

10/26/2016

Claim Changes

Reserve

Loss Reporting Location Code

520-CAREER EDUCATION REHABILITATION SERV

Net Expense Paid

INSURED VAN DAMAGED CANOPY OF DR JAKE CATES FACILITY WHILE

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $0.00$700.00 $0.00 $0.00 $700.00

Claim Total $700.00$0.00 $0.00$700.00 $0.00 $0.00

Liability Subtotal $0.00 $700.00 $0.00 $0.00 $700.00$0.00

Claim Number

2788058

Claim Status

Closed

Date of Loss

10/26/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

NOT AT FAULT - THE INSURED PARKED/UNOCCUPIED VEHICLE WAS

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $53.25$5,598.87 $0.00 $0.00 $5,598.87

Claim Total $5,598.87$0.00 $53.25$5,598.87 $0.00 $0.00

Page 37 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2776751

Claim Status

Closed

Date of Loss

10/27/2016

Claim Changes

Reserve

Loss Reporting Location Code

710-DEPARTMENT OF HUMAN SERVICES

Net Expense Paid

NOT-AT-FAULT - OV BACKING OUT OF PARKING SPACE AND HIT IV NO

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2778377

Claim Status

Closed

Date of Loss

10/28/2016

Claim Changes

Reserve

Loss Reporting Location Code

080-ARKANSAS GAME AND FISH COMMISSION

Net Expense Paid

FAILURE TO YIELD - THE INSURED PULLED OUT FROM THE GAS

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Liability - Property Damage $0.00 $44.78$3,738.38 ($283.61) $0.00 $3,454.77

Claim Total $3,454.77$0.00 $44.78$3,738.38 ($283.61) $0.00

Liability Subtotal $0.00 $3,738.38 $44.78 ($283.61) $3,454.77$0.00

Page 38 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2779627

Claim Status

Closed

Date of Loss

10/29/2016

Claim Changes

No Subclaim

Reserve

Loss Reporting Location Code

480-DIVISION OF CORRECTION

Net Expense Paid

NOT-AT-FAULT- OV SIDESWIPED IV AS IV TRAVELED DOWN HIGHWAY.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Not assigned $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Liability Subtotal $0.00 $0.00 $0.00 $0.00 $0.00$0.00

Claim Number

2778866

Claim Status

Closed

Date of Loss

10/31/2016

Claim Changes

Reserve

Loss Reporting Location Code

425-ARKANSAS INSURANCE DEPARTMENT

Net Expense Paid

BACKING -IV BACKED INTO PARKED AND UNOCCUPIED VEHICLE IN

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$1,136.87 $0.00 $0.00 $1,136.87

Claim Total $1,136.87$0.00 $23.43$1,136.87 $0.00 $0.00

Liability Subtotal $0.00 $1,136.87 $23.43 $0.00 $1,136.87$0.00

Page 39 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2780610

Claim Status

Closed

Date of Loss

11/01/2016

Claim Changes

Reserve

Loss Reporting Location Code

165-UNIVERSITY OF CENTRAL ARKANSAS

Net Expense Paid

TURNING - THE INSURED BUS WAS STRUCK BY THE ONCOMING

Paid Salvage Rec Subro Rec

Liability Limit

$1,000,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Liability - Property Damage $0.00 $23.43$1,523.14 $0.00 $0.00 $1,523.14

Claim Total $1,523.14$0.00 $23.43$1,523.14 $0.00 $0.00

Liability Subtotal $0.00 $1,523.14 $23.43 $0.00 $1,523.14$0.00

Claim Number

2781530

Claim Status

Closed

Date of Loss

11/01/2016

Claim Changes

Reserve

Loss Reporting Location Code

485-DIVISION OF COMMUNITY CORRECTION

Net Expense Paid

NOT AT FAULT - INSURED WAS REAR ENDED ON THE INTERSTATE.

Paid Salvage Rec Subro Rec

Liability Limit

$250,000

Net Paid less Subro/Sal

Collision $0.00 $0.00$0.00 $0.00 $0.00 $0.00

Claim Total $0.00$0.00 $0.00$0.00 $0.00 $0.00

Page 40 of 998Monday, March 3, 2025

ARKANSAS MULTI AGENCY Policy Number Liability Limit

$1,000,000Liability Limit

$250,0005248640

5248650

-07/01/2016 07/01/2017

Policy Number

Policy Number Liability Limit

$1,000,000Liability Limit

$250,0000683147

0683012 Effective 7/2023+

Effective Prior to 7/2023

Effective 7/2023+

Effective Prior to 7/2023

Claim Number

2820465

Claim Status

Closed

Date of Loss

11/01/2016

Claim Changes

Reserve

Loss Reporting Location Code

810-DIVISION OF WORKFORCE SERVICES

Net Expense Paid

STRUCK OBJECT - INSURED WAS REVERSING THE VEHICLE TO EXIT

Paid…